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,4=;% CITY OF PRIOR LAKE BUILDING PERM1� Date Rec'd
(// \. ,}I- TEMPORARY CERTIFICATE OF ZONING COMPLIA CE _
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`n AND UTILITY CONNECTION PERMIT U' 2)-, ty
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2. Pink City PERMIT NO. / V-11
3. Yellow Applicant ,
(Please type or print and sign at bottom)
ADDRESS Kids Count School Age Daycare - Bathroom Expansion ZONING(office use)
6880 Boudin Street, Suite #210, Prior Lake MN C-2-
LEGAL DESCRIPTION office use only)
t 5 /-cI 1.- von? 4t '4 e is i�jz $c v ci,ii `�}� >C i1 r s V71/- r '��- oLOT BLOC ADDITION ID P , f_'/? /-002— v
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Z.> -41 7V-("103 -c)
OWNER
(Name) (Phone)
(Address)
Contractor
(Company Name) Skyline Fire Protection, In (Phone) 763.425.4441
(Contact Name) Jason Mack (Phone) 612-408-4858
(Address) 10900 73rd Ave North, Suite #108 Maple Grove, MN 55369
TYPE OF WORK 0 New Construction ODeck ❑Porch ❑Re-Roofing ❑Re-Siding ['Lower Level Finish 0 Fireplace
['Addition !I Alteration ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ®Misc: NFPA #13, 2010
Type of Construction: I II III IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ 400.00
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 property and 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 revok- his permit for j st cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X / A �2--- C-008 8.21.2014
Signature Contractor's License No. Date
/
Permit Valuation Park Support Fee # $
Permit Fee $ 6,(75-1) ,,,) SAC # $
Plan Check Fee $ j „ ' �r.1 Water Meter Size 5/8"; 1"; $
State Surcharge $ l ,�U Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ i /07 Water Tower Fee # $
Mechanical Permit Fee $ il 1 11 Builder's Deposit $
Sewer&Water Permit Fee $ 666 Other
- i
Gas Fireplace Permit Fee $ TOTAL DUE 41.75 %
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•ca u, Bit r mes Your Building Permit When Approved aid 4' . ii Receipt No. I
/ _ Date ( ' I �_ By c
Buil ng Official D to !
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