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Oi PRt CITY OF PRIOR LAKE BUILDING PERMIT, Date 1
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE /9 / v
Z.1 x
AND UTILITY CONNECTION PERMIT �', 7
949vNEgO'(t' I. White File PERMIT NO / o7Q
3 pink Ap /2, 6 ,l
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
1 L k0 1 -(S - aPhithilL D.DorD=.0 ate D. ; o 21-6 N\ t-i .
1
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) ZFPS 1--)t en e S (Phone) — 7 Le 3' to 3°1 - 5 3 Wp
(Address) 5Z d j g En.) PI U €e . �/ �Di I 44.,.1 554743cv
BUILDER
(Company Name ' = + L - (Phone) 612 Z7v — q C.:2
(Contact Name) 7� -�'7- .�0_- (Phone)
(Address) /Jr' /4/#- cS • LE .,, jt, 1 L-e E_ � no?r- . 5Ce a 71
TYPE OF WORK ❑ New Construction ['Deck ['Porch ❑Re- Roofing ['Re-Siding ❑Lower Level Finish ❑ Fireplace
['Addition ['Alteration ❑Utility Connection / DQ C
CODE: ❑I.R.C. ❑I.B.C. krMisc.� 4 etrDA"1 ."''_E�7 -
Type of Construction: I II III IV V AB
1
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $ '
(excluding land)
Division: 1 2 3 4 5 i
{ I hereby certify that l have furnished Information on this application which is to the best of my knowledge true and correct. I also certify that 1 am the owner or authorized agent for the
above -• . •ed property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans- I am aware that the building
offi•.al can rev ke this permit foriust cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed i spections. • x r
' 7 1 Ci 0 € oT , -- 5,3.33 7 — ' j ¶// - -
Si Contractor's License No, Date
Perm Valuation Park Support Fee # $
Per t Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; I"; $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee I $ TOTAL DUE $ ■4/ 1 i
This Applica t ecomes Your Building Permit When Approved Paid 41- ? J R ipt No. 6 zO 9
q , I C1, q_______ Date / g %/ B
E;' " n ' trio, Date
This is to certify at the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447 - 9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372