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fPRlpCITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
AOTEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT /0 r l�
i ,
��ANESO�� l White FilY PERMIT NO. /U t /3
2. Pink Cit /
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZO G(office use)
511.9 Fet_l 1-lek_ 3 kip re 4-1--, l SR I
LEGAL DESCRIPTION(office use only) /19 — o/i. . 0
l AO %S ,4 ?15 D
LOT BLOCK ADDITION �� PID
OWNER A ;1 C e `L
1 L' rGC��61-4-O - (Phone) 62 12- 79'0 �t
(Name) I-
(Address) 15 2 e 3 FC,C\4-IGWJV\ i-,pry-S +r-et-1 1 J
BUILDER 1 /�,
(Company Name) �e�4 Ex `e\r--L Ar S (Phone) (125 i Li Le 0 (0 ( $,
(Contact Name) 5C,9 >•T J 4- ��-r iv\_ . (Phone) (,5 i trzi Pc)4,- .
(Address) C.-2- 3 C-1.--L. pp 4.?-An.C161-1.e.— v FtL.t/ w.► vi c f MA) S :2
TYPE OF WORK ❑New Construction ['Deck ❑Porch ❑Re-Roofing ORe-Siding ['Lower Level Finish 0 Fireplace
❑Addition ❑Alteration ['Utility Connection ,' { t
13-Misc. w � 0 W�
CODE: DI.R.C. I.B.C.❑ 0 - ,�11
CR)
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ 2 v
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5 l
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 sgent for the
above-me. sped proper • an. th 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
offic...t can r v .inhist. mi for ist cause. Furthermore,I hereby agree that the city official or designee may enter upon the property to perform needed inspec ons.
,' - C- CC3 /5 L> /r
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Signature Contractor's License No. Date
Permit ValuationPark Support Fee # $
Permit Fee $ l v SAC # $ ,
Plan Check Fee $� Water Meter Size 5/8"; 1"; $
State Surcharge $ 5 t `' 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 $ /)
P / C-
This Application Becomes Your Building Permit When Approved ''• /74).1,s Receipt No. -7,24_,,,
Date 10
By .-
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 Prior Lake,MN 55372