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��%RIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
A., 9
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE _
\,,3;)r'1 AND UTILITY CONNECTION PERMIT 7, /0. (Lf-
4,\,....
`t`NESo
1 White
2 Pink City CJSty iPERMIT NO. 1 L/. i(tom///
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESSI' f / ( a ZONINGI(office use)
L fE vtn C_irLl sE WAS f/
LEGAL DESCRIPTION(office use only) /l
LOT BLOCK ADDITION PID AT (01 • ,b 0
(ONaWNER rt m q&mewn 'z- (Phone) &CZ 0316 B(91
(Address) 4e 2 E- C.tvL1,L. Sf-
BUILDER
(Company Name) 4 IQ Ancr-1 Q..41:2=Ci,.tt k S tai 'Ie- (Phone)
(Contact Name) 4,..) R AI-v-sA v (Phone) C C2- g G'S (0(21'
(Address) 20L1 �vt.it.‘,%,t,l 54 rlw (.eciRv MN) 55 0 ll
TYPE OF WORK 0 New Construction ODeck ❑Porch Re-Roofing ORe-Siding ❑Lower Level Finish 0 Fireplace
❑Addition ['Alteration ['Utility Connecti o
CODE: DI.R.C. I.B.C. 0 Misc:
Type of Construction: I II DIP/ V AB
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ 1
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnishi-frnformation on this application 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-mentioned property and . • . coon 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 permit .� .' „ e. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
/i�.Fig 8C-,3O4t4( 77-ii `f
x / Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ 1 ! S.-- SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ ' Lit) 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 $ --/ Cl, 7 r.
This Application Becomes Your Building Permit When Approved Paid 'q,.7 Receipt No. 7,�'8 V
Date , /t:.J.- /L( By ,S.4AL 3
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
r 24 hour notice for all inspections(952)447-9850,fax(952)447-4245
C �� lDlti 3(03 3� 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
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