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PR/p CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,,o e TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
Air t iiii
AND UTILITY CONNECTION PERMIT
kovNESoo• I White File
P,nl, City PERMIT NO. f 4_,t c•
3 fellow Applicant " .-�
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
..e7 / ) 9 — .---,
t" 0 1. 14 1-.0 ,0 U C::
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OW)... (Name) L� ' l'vl C LcP e--Ii h I I I (Phone)
(Address) /&go c7 ' 5-,....)-er , (� �".,-4
BUILDERv n
ter- � ,_
(Company Name) J�D vl'1 F ` - l x-17 L C ' 11±f A-ff 5 (Phone) (0/ .� ' ""J 7 ?5 3
(Contact Name) ✓ i h'1 5 c= i'1. I A-t{ t� I / (Phone) / f
(Address) 3 G 5. tet. Yvt on C �"-, �� !1 , c C' 7- 4- 413:
TYPE OF WORK ❑New Construction ❑Deck ❑PorchRe-Roofing ['Re-Siding ['Lower Level Finish [I Fireplace
['Addition ❑Alteration ['Utility Con ectt n j� 1
•4 ❑Mise t./-rL T-C4 0 6 0dzA)4 C
CODE: ivAl.R.C. ❑I.B.C.
Type of Construction: I II HI IV V A B �-
T
yp PROJECT COST/VALUE $ �G Cie/
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 or authorized agent for the
above-mentis• • . operty and that all constiuction will conform to all existing state and local laws and will proceed in accordance with submitted plans I am aware that the building
official revoke t is permit foi Just c ise Fuit• molt,I he-eby agree that city official or a designee may enter upon the piopeity to peiform needed inspections
- X 1 `�J . ,S -d?—/
Signature Contractor's License No Date
Perm aluation Z� Park Support Fee # $
F
Permit Fee $ 14 1 C SAC # $
Plan Check Fee $ Water Meter Size 5/8", 1", $
State Surcharge $ 5 ..-- 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 $ 11
`1 S
This Applicat to • come . r Building Permit Wh - Appr• ed Paid 19L i R eipt No. 1( `1 PYA
I; Date Z,Z... (c{'
r `7 "Z i
Bu I t ' fticial�"
`_ Date
This is to certify that the iequcst in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may pioceed as iequcsicd This document
when signed by the City Planner constitutes a tempoiary Certificate of Zoning compliance and allows constiuction 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