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01 PR
ti CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE , 3 / �L
AND UTILITY CONNECTION PERMIT /
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EI.White File
2. Pink City PERMIT NO. i I
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3. Yellow Applicant
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(Please type or print and sign at bottom)
ADDRESS
ZONING(office use)
(4139 Ca l ora ut Sts 7 ,56
LEGAL TION(office uw sonly) 61--K ,
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LOT LOCK DITION )�S de, PID G? °01(' 'C')0,7 9" °
OWNER 4(1((/111.1
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(Name) X1 1(,,'v 1 C--W OST/ia.i‘'"UE, (Phone) q 1 1 (0 1 1 b) 7 /q
(Address) 1-1(3 C (*( S' ,?r( 1 L I m N g s ' ! 2
BUILDER j � ��l1�lYV
(Company Name) (SI U1' , f CJVl�"t 1114rWtistatfi(Phone) (Q 1 2-30.3 57P'
(Contact Name). � (] t! `�..� (Phone) 1�t 393 S.7At
(Address) V'"I 7"lV 1 I t�IXYZ [1 'STe 1 I Th O 1 M1 V CJ LH A
TYPE OF WORK ❑New Construction ODeck ❑Porch ORe-Roofing ORe-Siding ['Lower Level Finish ❑Fireplace
['Addition iteration ['Utility Connection �p( s
CODE: EJI.R.C. DI.B.C. ❑Misc: ✓ brV V e i .C . 3 ( -
Type of Construction: I II III IV V A B $1 IS-
Occupancy Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ 2 J Z.J 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 rev ke this permit for j t cause. Fu rmore,I hereby agree that the city official or a designee may enter upon the property to perform needed ins ections. ,
X 3c 3 ( 9�3 �- g / / L
re i Contractor's License No. Date
Permit Valuation // Park Support Fee # $
Permit Fee $ k3:41I
SAC # $
Plan Check Fee 11, Nater Meter Size 5/8"; 1"; $
State Surcharge $ i, 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 / $ l `
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This Application Becomes Your Building Permit When Approved c q , r) C�
Receipt No. 11 t1
Date
By � 2.
9 Building Official Date t „. k
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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 dccument
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
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