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of PRI0 CITY OF PRIOR LAKE BUILDING PERMIT, e1r Date Rec'd
0TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �/
AND UTILITY CONNECTION PERMIT
44NESOlt• r White CitFilePERMIT NO.
2 pef :.
Yellowftty Applicant /
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
595q— CS 0SSr('0‘. 54-cec-t. 30 4, £os-+-
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER `j C� c _ `5 p
(Name) br 'o Y� (Phone) /5d�' ��b _' �CLj YO
(Address) (cD; 4e..)
BUILDER
(Company NamecKtY1cl )Ol1 -l{ A -e( j2(\..) (Phone) (051-
aro 9 —LICE g,
(Contact Name)
'M1 `(Phone) 6CIAcJCI,fv)
(Address) 1lad co. 1 "G tl WeS+ i -Koseu1�.k1 1M sS/) '3
TYPE OF WORK 0 New Construction ODeck ❑Porch ORe-Roofing ORe-Siding OLower Level Finish Firepla e
❑Addition DAlteration DUttlity Connection �e s1 „ n ; mss a 3(Icor& W/�N
CODE: ❑I.R.C. ❑I.B.C. '0 scl.(.1. t S ;
CO
Type of Construction: I II III IV V A B PROJECT COST/VALUE a 0 0 5
Occupancy Group: ABE F HI MR SU (excluding land) i
Division: 1 2 3 4 5
I hereby certify that I have furnished infoimanon on this application which is to the best of my knowledge nue and correct I also ceitify that I am the owner or authorized agent for the
above- entioned property and at 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
otTici. -an revoke this peimi.for ist cause Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections
X et--) __�13oC1 33 b I /
Signature Contractor's License No Date
Permit Valuation 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 $
Gas Fireplace Permit Fee $ TOTAL DUE $ 7
9 7.5
This Application Becomes Your Building Permit When Approved Paid 7J y, 7 Receipt o.,
Date ..L.,////5L By /,,
Building Official Date
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 Ceitdicate 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