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Ju1251401:45p Xpand, Inc. 952-697-3355 p.2
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,y�i�I04' CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
6— / \ \77 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
I"1 \...,)
�' AND UTILITY CONNECTION PERMIT f z s--- I LI .
�NES�
I. whip riIn
2. Pink Ci ty PERMIT NO. //�
Please 3. Yellow Applicant / t r
( type or print and sign at bottom)
ADDRESS ZONING(office use)
I c.) /N ino'-i� .)c.v- t,c`C:'a\ i F \r.! l7' -y- Lcth C`I‘N--) / /
LEGAL DESCRIPTION(office use only) "�+' /� •
LOTl BLOCK2 ADDITION l it) GQS 5-A..., T—/� PID �` 3� `(.� ���'''
OWNER y�
(Name) . h'�I';Er._ ri L)�'. O C.N (�;t (Phone) 'k-✓r `giin ' 57 qF S
(Address) \ 37 cl \.),(- ^C'� ),:',CV- --c-:(N oA 1\1 v_, :--,o!' t olvk ,Nik'k)
BUILDER
(Company Name) 1''poC\CL `1"'1Q (Phone) C4'7,'4 — :RC/. _-CC!37
(Contact Name) 5 `- Hr';.if (1',.l'G (Phone) C_- 1 - K.2" (-)7
(Address) ! )7Z27 -* ,.�\(Z - , t 7: .-- : CIA '-3"."):^,6-1/4.., �s(\c-4.— '1`. N ;J
TYPE OF WORK ❑New Construction ❑Deck ['Porch Clic-Roofing Re-Siding ❑Lower Level Finish ❑Fireplace
❑Addition ❑Alteration ['Utility Connection < c
CODE: ❑I.R.C. ❑I.B.C. 0 Misc: :,�(\:,f\f� ') 9 < L c3:.(VA C.
Type of Construction: I II III IV V AB ,i
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ D 'Oc) > 1
Division: 1 2 3 4 5 (excluding land) ` a, ho
I hereby certify that T 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
ab tionetd ptstyeaLthat all construction will conform to all existing state and local laws and willproceed in accordance with submi ted plans. I am aware[trot the building
rev this pout foTi�l' st cause. Furthermore,Thereby agree that the cityofficial or a designee may enter upon the property to perform needed inspections.
' Signature Contractor's License No. Date
• Permit Valuation ` A c
Park Support Fee # $
Permit Fee . SAC # $
4
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ - Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # S
PlumbingPermit Fee $ U Water Tower� 1 o er Fee # $
Mechanical Permit Fee �� Builder's Deposit $
Sewer&Water Permit Fee $ tut Other $
Gas Fireplace Permit Fee $ TOTAL DUE $
This Application Becomes Your Building Permit When Approved Paid q t /i ' Receipt No. ( ig
rit-
Date ^ 74, t 4 By k-
Building Official Datc
' 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 requestS.sTlvd 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 mint be
issued.
I'Iarming Director Date Special Conditions,itany
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372