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of PRIo�P CITY OF PRIOR LAKE BUILDING PERMITS Date Rec'd
,, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT 47_ /ci
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+0,„ESolt• I. White File
2. Fink City PERMIT NO./L/ �O�./
3 Yellow Applicant //
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
I 10033 No{ Toc..01 l0 /Se
LEGAL DESCRIPTION(office use only)
LOT (/ LOCK ADDITION A'O t 44 O PID R5— 01,--E Yr/—/
OWNER,_. p
(Name) 1 ht�` cNCA_S ID A S t Y1 (Phone) 9 —441 4 / C>5
(Address)
BUILDERQ c
(Company Name) �f\f L YL D� (kr8-etse..A (Phone) lghS) —pato 9 'y d Sl_ __
(Contact Name) `` - ` \ (Phone) Ef(,�((JJQ,�)
(Address) 19 a 0 CO .R"C '' Go-e ST Fp Usev;Lt-e1 1 55 113
TYPE OF WORK 0 New Construction ['Deck ['Porch ❑Re-Ro fing ❑Re-Siding ❑Lower Level Finish ❑Fireplace
DAddition ❑Alteration ❑Utility Connection t0o.C.Q 2 lLif lMaCkj.)S alirrf ld•fl`h
CODE: ❑I.R.C. ❑I.B.C. ❑Misc.4Q11(`sS+'r5
Q co.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ 9 1 �1 4-0
Occupancy Group: ABE F HI MR SU (excluding land) I
Division: 1 2 3 4 5
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 z.gcnt 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.
Xt kc\36 533 a35 ILI_
Signature Contractor's License No. to
Permit Valuation / Park Support Fee # $
Permit Fee $11/( 75 SAC # $
Plan Check Fee $ 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 $ 2Ye
This Application Becomes Your Building Permit When Approved �' ( Receipt No. Tj i- r
Date! �- 1-(1By
-7
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. 'Ms 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 Prior Lake,MN 55372