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01PRto* CITY OF PRIOR LAKE BUILDING PERMIT, Date,Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT 1 0- I S--. /3
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1.White File
2. Pink City PERMIT NO. l3 /// i//�' /
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
/WA-1-1 r \AOM-F CA \la NW ptiD
LEGAL DESCRIPTION(office use only)
-/ r
LOT BLOCK � ADDITION C- �D®a S A.T 44 e_ Gtil tekis PID 075' 3 830 3 ‘—o
O((NaWNER POVfl Q, VD* (Phone) C 2 'A - "✓(0
(Address) G A Y ba wui� CA rc , N W PVI car LO' \ D-13"/2
DER
(Company Name) t,,l/V O1 (Phone) t012--- • i L✓. V o4�
ne " 2- i
(Contact Name) \la ff 1 l� 1 ( l ' ( !�(Pho ) �G7 a /�
(Address) k\QD s Q I t t� Y , V SlM J P l�'V Y Jl
TYPE OF WORK 0 New Construction ODeck ❑Porch )4e-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace
['Addition ❑Alteration DUtility Connection
CODE: ❑I.R.C. ❑I.B.C. 0 Misc:
Type of Construction: I II III IV V AB I A uJ VD �Io
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ ) uJ l/ . ,
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-ment t -. :op and that all construction w ,nform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official c. revo e this. it fo�ust cause. j 414
hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x MIA A A A Cg-Db\ t:) --I) i 00 1 3
_ fingn7Te w Contractor's License No. Dat
Permit Valuation Park Support Fee # $
Permit Fee $ g� SAC # $
Plan Check Fee $/ Water Meter Size 5/8"; 1"; $
State Surcharge $ /,, at) 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 $ '77
This Application Becomes Your B 'ding Permit When A prove `7 • Receipt No. D
a 111
' 0 I Date 7 t s By
Building ODate
This is to certify that the est 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