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04 PRj0.P CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE /p `� ti---
v F� AND UTILITY CONNECTION PERMIT £! `
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1.White File
z. Fink city I PERMIT NO. `�� 577
3.Yellow Applicant
(Please type or print and sign at bottom)ADS ZONING(office use)
1X521 W\+ SW
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWN (Phone) 00-7 .2:100. -✓ �7 (
(Name)ER__�� V Z/V t,J`�/�
(Address) \ C2 1JVu I l-i RVQ Q vA p V t Imo" ` '"" '`J -1
"✓ v
BUILDER seta. Z !/✓ Q�'1�•Y
(Company Name) � � (Phone) f)A�� /1'17f��2��
(Contact Name) i-�/17/�t` 1�j tr t t outs- [ / (Ph`on'e ( q I P3
(Address) 4 tO0 P aiC IS% t �J111 VI- S 4 Pa I , M N `�
TYPE OF WORK 0 New Construction ❑Deck ❑Porch ORe-Roofing ORe-Siding OLower Level Finish El Fireplace
❑Addition ❑Alteration ['Utility Connection (�` C�W 2 1 i G /�'�
CODE: DI.R.C. DLB.C. ✓ lisc: pO/1 ,J, I I v I I `'
I II III IV V A B /�,Il(1 r}
Occupancy of Construction: PROJECT COST/VALUE $ I " ► D V ' V
Group: A B E F ]3 I M R S U 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 certify that I am the owner or authorized agent for the
above-men_'...• .. and that all construction will conform to all existing state and local laws and will proceed in accordance with to perform glans.d i I am aware
that the building
offici, perntit for j ,v�� .• ,I h. by agree that the city official or adesignee t�YMO 0�tel'u)" �property pe � I/] I i 4_,R (� Contractor's Li/iceensseA,/Nioo.. /Datate
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 $ _TOTALD'Jf� �fUE (� -71.5-1-7
This ApplicationG Becomes Your Building Permit When Approved Paid `- ` ✓ Ret t No.
Date (3_ /1.
I By I
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