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OF PRJ�� CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
,,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE°-.•/.
_ M1 /
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AND UTILITY CONNECTION PERMIT �7 r /� t
y/NNESOP' I While File 7
2 Polk City PERMIT NO. .,i ,
3 Yellow Appheani
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
9 q C Q0f:EN6Ab(Zi_. 5"k
LEGAL DESCRIPTION// (office use only) 1
LOT/r. ADDITION�Jyn,;k>c-',' L// 4-`9`5 6, `/t PID / fl 'C/26�'b
OWNER
(Name) ? Lt )LUr r4 (Phone)
(Address) 5 a 01 D. C„,7_,0 �)Q2'L Sr, ¶ Z_
BUILDER
(Company Name) ( o'--`) '''' '74.2--- C i 'Q ,t,-CS 0� (Phone) Co \--. ' da\' a.AS
(Contact Name) 3AB (,pto'S"7,4,4 (Phone)
(Address) ? \. �L 3:>a-. `,‘..-‘A�JP` - 1 `-4 s `le\
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TYPE OF WORK 0 New Construction ❑Deck ❑Porch Z'(Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace
❑Addition ❑Alteration 0 Utility Connection
CODE: ❑I.R.C. ❑I.B.C. 0 Mtsc
Type of Construction: I II III IV V A B OD
`PROJECT COST/VALUE $ 3 oo
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct I also ceitify that I am the owner of authorized agent for the
above-mentioned property and that all contraction will conform to all existing state and local laws and will proceed in accordance with submitted plans I am aware that the building
official can revoke this petmtt for lust cause Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections
x _________TL-Le L C Q-6 'D 5") S ' l V, • 01
Signature Contractor's License No. Date
Permit Valuationf i Park Support Fee # $
Permit Fee $ ��� / ' SAC # $
Plan Check Fee $ `� ( ) Water Meter Size 5/8", 1"; $
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 $ _......3.Gas Fireplace Permit Fee $ TOTAL DUE S l r7'..t '
This Application Becomes Your Buil'dring Permit When Approved Pak__ ))C( ` i c Receipt Nei ) 7
2 . '� , ( 7 Dat' l7i ( ( - ( Li By ,--1-1 - '-
Building
Building Othcia 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 iequested 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 ail inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372