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�� CITY OF PRIOR LAKE BUILDING PERMIT,
Z.
,/ 7 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Date Recd
�' AND UTILITY CONNECTION PERMIT
I.whne File I PERMITI
3 p City NO.f ���-
(Please type or print and sign at bottom) 3.Yellow gppl cant
ADDRESS
ZONING(office use)
/�[J�
- ]- / LVQ1 rU) TRA)1 /IA F.
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION
PID Q?`�—�L(3--0)to'a
OWNER V V fT'0 lV R at3/V ikl G
J (Phone) t,I7.~ 9D3—
<<�
(Address) /I/Q^I Z .6L OE B g.0 'AAtL
IV. E.
BUILDER ���
(Company Name) 4401.1 R,%1 . 1 VX"1'101) (Phone) 2— '/ /Z— /762..>
(Contact Name) 0012.2s(
f n
��(4) ��"V I�'+��.� A •/� (Phone) 0 1Z•??,3 . 4/63Z,(Address)
A OlzKr4, /�1/v c573-3/8
TYPE OF WORK 0 New Construction ['Deck DPorchRoofin
OAddition DAlteration g ORe-Siding Lower Level Finish 0 Fireplace
❑Utility Conn coon
CODE: DI.R.C. DI.B.C.
Type of Construction: I II III IV V A B 0 Misc:
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ g 7o0. co
Division: 1 2 3 4 5
(excluding land) �
aboI hereby ce .fy that I have furnished information on this..p' on which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above-men..ne, I .perty that all constm,.o , I (
can arty t andor just cause. r . „d 1 to all existing state and local laws and will proceed in accordance with submitted plans I am aware that the building
a �, agree that the city official or a designee may enter upon the property to perform needed m ons.
X �- ,act.z 712 '76 Aye?9 e ,3
a 0 e 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
$ 17yq5
This Application Becomes Your Building Permit When Approved
Paid r`fv:'7S 1 Receipt No. 70/4Q
Date /0/9//— BY .$t'C,r
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 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 S.E.,Prior Lake,Minnesota 55372