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�Y OF t'RIOR LAKE BUILDING PMIT, Date Rec'd
Q, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ', Di
AND UTILITY CONNECTION PERMIT 6
414,,E so1P /Vii/,/ , ,e. AOir_/z43
I. White File PERMIT NO.
2. Pink City '_/? Q/3
3. Yellow Applicant (• ((��
(Please type or print and sign at bottom)
ADDRESSfZONING(office use)
1143,c (ark
ark /V /i -1- ,- v-L , C4-
LEGAL DESCRIPTION(office use only)
LOT Z BLOCK Z-ADDITION /2/91'e./c- /t/!e-4((2 7 PID 25-39/—3'/— oe -0
OWNER pi _
(Name) t 7 s 7 o n t O r r 1 o r L� -c, (Phone) 9 5—I— 22 6 —3 7 I5
(Address) `� b15c At
co eoI/tTA✓-c . / P/ . vr LIit-e_ -
�// - 537
BUILDER
(Name) /V v r f-I, IAA I re.r ac.- e=re, £ 4e c c, c i.f l/ (Phone) 952--i/3 -d /0.-
(Contact Name) s f e.V z- 6-t Ai Z. (Phone) 5A t .c-
(Address)
(Address) Lf 5 1!✓. ..7
.7 7 0- 5 f. 36.14.017,25- M •�cn i c.410 D�`S , /t//� c5 `/ 3 5-
TYPE OF WORK 0 New Construction ['Deck ❑Porch
❑Re-Roofing ORe-Siding
['Lower Level Finish 0 Fireplace ❑Addition ❑Alteration OUtility Connection
%Mise.A m S 4 I Fr,r e. 7„.pert cS)4.h PROJECT COST/VALUE (excluding land) $ '7 y 7�('0ffiiff���Ihereby 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 thatthe building offi ial can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
enter u•onthe .rop-rtytope o needed ins.= ions.
k...ia
Signa e Contractor's License No. Date
Permit Valuation ICC'.00 Park Support Fee # $
Permit F6 $ 35.76 SAC # $
Plan Check Fee $ R3 .20 Water Meter Size 5/8"; 1"; $
State Surcharge $ ,50 Pressure Reducer $
Penalty $ City SAC and WAC # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE /,,,,,„j- ,•/4 of $ 51. .1-0
•Ocr 8n ecomes Your Building Permit When Approved Paid $.9. Receipt #1°6 9/
7 At C o Date 62�,6� By
Buil• g 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 Occupar cy must be
issued.
Planning Director Date Special Conditions,if any
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
16200 Eagle Creek Avenue Prior Lake,MN 55372
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