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��� CITY OF PRIOR LAKE BUILDING PERMIT, Late i �:t
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
U AND UTILITY CONNECTION PERMIT / - q. is
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PERMIT NO. _✓��—
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3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
5035 ZO5TYt 04 5E �ic74/dice m/ ,5:537 - S
LEGAL DESCRIPTION(office use only)
LOT BLOCKlet
ADDITION , — 64 PID ‘117C— /t" -i9,6- - V
OWNER pa
(Name) coo b a (Phone @52) 2[7— /
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(Address) 56 35' IDS7 ie!? ) c cic 5E /4"o.G in- 14,4 5- 7?'.-
(Company Name) INEGG4 ,Coeeeeorrs (Phone) `13C300 ______
(Contact Name) /oar O&1&f& -r-exv (Phone)
(Address) 3?3 F /&Atte t,e - 4e /ab S7 Lows ,e,,,G4 Net/5:5V14-
TYPE OF WORK ❑New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace ,
EAddition EAlteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. Misc: 4Mce C 4/ri,0040511 7fd criSrr417; CITYe7 64e
,
Type of Construction: I II III IVV AB l
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ / 7
Division: 1 2 3 4 5 (excluding land)
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-mentioned prope -, d that all construction 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 re • th• it for just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x .... G'6147 cl(l°l 6-13-ir
Signature Contractor's License No. Dac.
Permit Valuation Park Support Fee # $
Permit Fee $ �7` 7 r� SAC # $
Plan Check Fee $ ,[/ J Water Meter Size 5/8"; 1"; $
State Surcharge $ J`'_en) 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 $ ti
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This Application Becomes Your Building Permit When Approved 1 f- /=� Receipt No. ��.
ate ` L./ � / By
Building Official Date T
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. Tits document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,a Certificate of Occu r< icy 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