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O F PRi CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE r/
LI x AND UTILITY CONNECTION PERMIT /0 . I t ' ,3
4inresot". I. White File PERMIT NO /3 I / /
_.- 2. Pink City
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
LI 133 \ ►dden Oc\d Icon :\ iNE. R 1 6..
•
LEGAL DESCRIPTION (office use only)
LOT 5 BLOCKS ADDITION SIer f y R 1 ( � e,, � ��4 A PID 0 5-- R61-- 02' -
(Name) 0.■ \ c OAct. (Phone) 95o - 9$3 " 1
(Address)
BUILDER __ p
(Company Name) -e W o Q �rtf�') (Phone) G61 "0710 4' L1085
(Contact Name) (Phone) Btbexty
(Address) 11 CD, • ��C ` L j N)se.uillt� nrvry S5 cJJ
TYPE OF WORK ❑ New Construction ['Deck ❑Porch DRe- Roofing DRe- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition []Alteration ['Utility Connection
CODE: DI.R.C. DLB.C. ❑ Misc. ``
ate CAW t h *4-P4 is ;
Type of Construction: I II III IV V A B 5, " 7T 1 / ■ . OO
PROJECT COST /VALUE S 'O�
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that t have fumished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
I I above- n toned property and t ail construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official c revoke this permit or j st cause- Furthermore. I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X g G 130 83 5Oc rs
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ /5 ii: < 7( SAC # $
Plan Check Fee $ ,! Water Meter Size 5/8 "; 1 "; $
State Surcharge $ 5- ` OV 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 $ TOTAL DUE 1
This Application Becomes Your B • . ing Permit When Approved Paid C1 0, 7-13 Receipt No. "0/��
Jq/
. L�3 q , J3, Date // IS By ` Bt dmg Vinci Date l
This is to certify that 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