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of PR/p� CITY OF PRIOR LAKE BUILDING PERMIT, Date K
7 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE G - f `¢
AND UTILITY CONNECTION PERMIT U
to
'yj�NEs��� I. White File PERMIT NO. I�xf
Pink City �� `7f�
3 Yellow Applicant fff / .
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
/4379 .,.JIe7v!2tA CUA sE_ (?2,40,1a_ LJ 0/4)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) / 12461' 4_1.."1 1 'O 2 ALN (Phone) 657- ?6 9—5-6,36
(Address) /63 7 v / Cro2/A- C✓2.V L. .6 , r2/O k (.,..Lid= L 27Z
BUILDER
(Company Name) C XJ 6 002_ 5 O/_V i/Liv_ _2---i./e__ (Phone) 9,5—,2- yyo--im/
(Contact Name) ..,17.4/ . (Phone) 9379-291-b Z-345
(Address) /2.3%/ ,30u fv2K.,_ 6.2 /vz /92/0t2 L44L
TYPE OF WORK ❑New Construction Rieck ❑Porch ❑Re-Roofing ORe-Siding ❑Lower Level Finish ❑Fireplace
DAddition DAlteration ❑Utility Connection
0 Misc. /2 -S�InJ Z . Ali 1...) 7..-4/G./A.A.,
CODE: ❑LR.C. ❑LB.C. /
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ / // .2z ("A.
Occupancy Group: ABE F HI MR SU (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-mentioned propel and that 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 revoke this ermit for t cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspe tions.
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X r 3ca0623379a
Signature Contractor's License No. D to
Permit Va ation 7 ,,,eni Park Support Fee # $
Permit Fee $ e-�C.,CJ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
f .. Z,i
State Surcharge $ , Cl/ 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 $ Zky `l S___
This Application Becomes Your Building Permit When Approved Paid /- 7 S Re pt No. #j/'q 9d
-_-_il
Date 0 IR /4-- By
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 Prior Lake,MN 55372