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04 pRj0+P CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Z 2--$ /4
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AND UTILITY CONNECTION PERMIT
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I.white File
. PI PERMIT NO. `4_ 121 1
3ellCity
3.Yellow Applicant
(Please type or print and sign at bottom) ZONING(c ffice use)
`�$o1 &r9,erl 1- R1 ots T 't \ 1
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID OWNER r,, V4 'n /Q (Phone) "I�2.. --7Cf7 , 4-0(.97
(Address) 2,c,( brew wAqvilL Ty ' P1 i 01( N/vQ ) F12
e J v v-Nati (Phone) VQ I2 - Lam✓ •'DkLP
BUILDER
(Company Nam ) Qi W�- )��, Z,-�
(Contact Name) i t, (Phone)
(Address) 4100 Y(IS tor &i d- St v OU►S Ptd.► , MA 1
TYPE OF WORK 0 New Construction ['Deck ['Porch ORe-Roofing Re-Siding ['Lower Level Finish 0 Fireplace
['Addition ['Alteration ['Utility Connection
CODE: DI.R.C. DI.B.C. 0 Misc: OD° IType of Construction: I II III IV V A BJECT COST/VALUE $ !Occupancy Group: ABE F HI MR SU �7pRO )(excluding land)
(YD---
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 agent for the
above-men i.n . ,••erty and that all construction will conform toall
existing that the city official or a designee may ws and will enter upon the property to perforoceed in accordance with submitted d d in I acmti aware that the building
offici. permit for ju . ' by �
. 2h.
�1 .l A C DOt'0� 2
R &`'` `- Contractor's License No. Date
II �� fit-
Permit Valuation
Park Support Fee # $
Permit Fee $ SAC # $$
Plan Check Fee $ Water Meter Size 5/8";1";
State Surcharge $
Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $$
Mechanical Permit Fee $ Builder's Deposit
Sewer&Water Permit Fee $ Other $$
Gas Fireplace Permit Fee $ TOTAL DUE
This Application Becomes Your Building Permit When Approved Paid
ER
�g,, 7,r R eipt No. 7(��Date / Z 3 /`f
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