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„AE, CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE .
U AND UTILITY CONNECTION PERNIIT
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PERJ1IT NO.
3 Yellow Applicant
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(Please type or print and sign at bottom)
ADDRESS /� /�� /� �'
��� �U•�U i` rY� l/�• ���U f /�, -3-1
ZONING(office use)
I t ` 1—F�.2 y, m t\1 — 3-11
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION
PID
��IVB-fih�..n �r-1S�i n Or )NZ—? ?\ - 0 (1� (Phone) ”" ` 6.
(Address) 3 ) rnoJcim - PflY La YYkiSc,'37-a
BUILDER
(Company Name)
1 \ (Phone)(Q'S I -1 'S 4-.-(2
(Contact Name) y
(Address)4-�l4 . ` . l . . pus �!/�w Al m N SSO Ju y el `als OD�1remode;tei inc.COm
TYPE OF WORK 0 New Constructio AIM OPorch
DRe-Roofing 0Re-Siding ['Lower Level e)ginish Fireplace
CODE: 3��+ C. pI.B
DAdlliti
.C.on Alter:... .7.tility Connection
a 1
\A 0, o.ec�
I II III IV V A B
Occipaucy Group: A B E F H I M R S U PROJECT COST/VALUE $ r Ni 06
D �° 1 2 3 4 5 (excluding land)-
I hereby that I have
furnished information on this application which is to the best of my knowledge true and correct I also artify that I am the owneror authorized
abo tinned and that.
hat all construction will conform to allexisting state and local laws and wi71 agent for the
dB ' an revoke "t just cause.Furthermore,I hereby agree that thepenterd io the props with e f rm n Beds. I am aware that the building
a� I YI � city official or a designee may enter
� upon the property to P�'�needed' ons.
ifir
Contractor's License No. D 1 )q
ate
Permit Valuation -36x..0, .. Park Support Fee #
Permit Fee
$ f'Z5- SAC # $
Plan Check Fee $ Water Meter 5/8";1";
State Surcharge $ I.�7� 5G' Size $
s0 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
14-t((
This App . . ;. , our BaildintPcnnit When . tcl
� Paid rL}'1�' [ I Receipt No. 7( L�,�,
,
;� S- Date S// 1 14. By Rom I
!.
Building Offi'i:: _-,--- s:te
This is to certify that the request' the above application and actin an
when signed by th P p ymg locum. ..is in.ccwdance with the City Zoning Ordinance and may proceed as requested. This document
!It;
cons .us a temporaryCertificate of Zoning tom.. .,(xis
d allows construction to commence. Before occupancy.a Certificate of Occupancy must be
issued. / ilk ,
� �� � l
Planning s or D e
24 hour notice for all inspections(952)447-9850,fax(952)447-4245 Special Conditions,if any
j646 Dakota Street S.E.,Prior Lake,Minnesota 55372
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