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01 FRI0, CITY OF PRIOR LAKE BUILDING PERMIT, c' Date Rec'd
` TEMPORARYCERTIFICATE OF ZONING COMPLIANCE
AN /
AND UTILITY CONNECTION PERMIT 4 .. ��
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1.White Fie
. PPERMIT NO.
3
3.Yellow Applicant 13
1 /
(Please type or print and sign at bottom)
ADDRESS ZONING(aa ice use)
1101 IS Ly0v15hie} Ai154
LEGAL DESCRIPTION(office use only) -
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LOT( 3BLOCK / ADDITION y" it,0/e. ,. :, U /- PID 2-S'el 7_61/3 —0
OW(Name)R I 1 IUli1 L( Y 1L' VCtx) Te,ri r6 (Phone) Li I 2-.- Cl(,O` "' .6'Ip l
(Address) l 1 —1 � c LA., O in S Ave( Priby La_'K
BUILDER
(Company Name) e Ck €x-f- rl Ors (Phone) 11#31(�in
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(Contact Name) C1 "COSt +0OS (Phone) Li 12--U/A 00.5.5
(Address) Y--J-43 '8 Auto tiCO# ( _ vier m1.)
5C-- 14-1
TYPE OF WORK 0 New Construction ['Deck ['Porch IRe-Roofing ORe-Siding ['Lower Level Finish 0 Fireplace
['Addition ['Alteration DUtility Connection
CODE: DI.R.C. DI.B.C. 0 Misc:
Type of Construction: I II III IV V AB ,
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Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE S lY 1 O 0
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 tt:e building
official can revoke this pe ...4'._lust cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspe ons.
X 1G if 3 S5 qg 6/ 2-1 /
Signa Contractor's License No. Date
Permit Valuation / Park Support Fee # $ ,
Permit Fee $ jJ 7, SAC # $
Plan Check Fee $� 6Y3 Water Meter Size 5/8"; 1"; $
State Surcharge $ 5- 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 $ 79'r
27�
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This Application Becomes Your Building Permit When Approved 1 '' / Receipt No.
2. it7
Date cil
!✓�? ( ti By
Building Official Date
5e
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