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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT ' 30 .
4rk1 ES v
1.White File
2. Pink city PERMIT NO. /4 342
3. Yellow Applicant •
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
:_ 4 1 t- t • t c,,- ✓ t v c..�.. l� Z
LEGAL DESCRIPTION(office use only)
LOT: Z-BLOCK Z. ADDITION t r,o� t ivy. a , ,., PID 2-C: 352, 0 0 3
OWNER COQQ Q
(Name) L ' E r i J Sc�m (Phone) I Z.. tt.C) [�C fT
(Address)
BUILDER --Th p Z- -
(Company Name) — ..�p`h v�, � Li 6..--r..6..--r....5, 1(-r� (Phone) 41 C1 °' `/1- ,
(Contact Name) ---C- =. ---LL�L v`- )'
(Phone '�1 (off Z— 7.4. _ 13 O
/
(Address) C(- C,,A., St I cir► uki:v..�-.. ) IN11\ S 6 3 G 1
TYPE OF WORK 0 New Construction ❑Deck ['Porch ORe-Roofing ORe-Siding ['Lower Level Finish 0 Fireplace
ddition ❑Alteration ['Utility Connection
CODE:igi.R.C. ❑I.B.C. 0 Misc:
Type of Construction: I II III 1V V AB
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ (4t, 3'i
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 revoke this permit for just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X4 1 _10.).— �
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(D-ol 4 3 g 4/-E._ c
Signature Contractor's License No. Date
Permit Valuation l 5-1 o vo, — Park Support Fee # $
Permit Fee $ 2--C>5-- 2-c- SAC # $
Plan Check Fee $ (-7 z , 4- 1 Water Meter Size 5/8"; 1"; $
State Surcharge $ 1, SJ 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 $ 44, (G
?er..4/. .S/ /it .2.NP r''l (o/ ��/¢-'
This • :on Becomes Your Building Permit ' n •• . .ved Paid •' - & R ipt No.
r/5f75—
�I '' J l Date `�l
iedf .'n• •. D. e
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 P er constitutes a to.porary Certificate of Zoning compliance and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued. * — T.--/2.,--/y-
,
Planning P.' for Date Special Conditions,if any
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
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