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PR/01:.
CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
., TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT i���4)4 (4C
k,,,Eso
I. write File pERMIT NO. M1,1
2. Pink City
3.Yellow Applicant •
(Please type or print and sign at bottom)
ADDRESS ZONII Cj(office use)
/s3 f$ d& % a, less j/r<�-I
LEGAL DESCRIPTION(office use only)
LOT(0 BLOCK ADDITION illf JI IC1 5dil , PID ci2f5 3-15-(t(.OWNED
(Name) Jeep.- P00.410/4,K0 k.(• (Phone) `i '. Siop �'
(Address) ir3?S.° /ICs /Yorst At.,
BUILDER
(Company Name) PO Itl y- 13 v!!C4 42.4e,5 •rti G, (Phone) fr/='ivS" "0
(Contact Name) C,CU,otr.,iu. Ct.#111aSioi (Phone) 743 3T0 007 I'.
(Address) //&3 G✓ Adras e,t" fikei /f, nwalswiliey 'i
TYPE OF WORK 0 New Construction ❑Deck ❑Porch ORe-Roofing ❑Re-Siding ❑Lower Level Finish
0 Fireplace
❑Addition^Iteration ❑Utility Connection
CODE: ❑I.R.C. ❑LB.C. 0 Misc: he L ?dZ StAi Qerly
Type of Construction: I II III IV V AB
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ /4 006/
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 ' and that all cons tuctie li.confo to all existing state and local laws and will proceed in accordance with submitted plans. I am are t it the building
official. 'r' is permit for just a . Fu ore ..'.by agree that the eity official or a designee may enter upon the property to perform needed'. . . ons. /
Signature Contractor's License No. D to
•
Permit Valuation Park Support Fee # $
Permit Fee '
$ 7 7 S SAC # $
Plan Check Fee $ Jr (.I) Water Meter Size 5/8"; 1";
State Surcharge $ 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 q q. I-c--
This Application Becomes Your Building Permit When Approved Paid i 4' Receipt No. 16:,3
Date .- (
1 d `f By 31/14.4-�
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 S.E.,Prior Lake,Minnesota 55372