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of PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
7 - - (17
,� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE _
i AND UTILITY CONNECTION PERMIT /6), '
v �,
4/A'NE SO, I. White File ?
2. Pink City PERMIT NO. < /q/
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
£o3s Act-A(4\ 51 AE ritor L, e. MN ),
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER /
(Name) �iif ' (Phone) 6 r cOlti
(Address) 10530 5V W L1Lii1k MN ssis
BUILDER -
(Company Name) 10 CCjnl-rt LLL (Phone) .2 ?-4' 7‘u
j
(Contact Name) -JhSG(n Albfr//ntiil►% (Phone) ��,(�
(Address) JS1 UV jU-Ytil 4v Ai; 5r!k ' 7 C' AZo , spits--
TYPE OF WORK ❑New Construction ['Deck ❑Porche-Roofing ❑Re-Siding ['Lower Level Finish [IFireplace
['Addition ['Alteration ['Utility Conn do
CODE: ❑I.R.C. ❑I.B.C. ❑Misc.
Type of Construction: I II III IV V A B J a?
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ /�f Cdr
(excluding land)
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.gent for the
above-mentioned propel at all const-tc' n ill conform to all existing state and local laws and will proceed in accordance with submitted plans. 1 am aware that the building
official can revoke this rmit fo,)ust c - u er ore,I hereby agree that the city official ora designee may enter u o h property to perform needed nspections.
Signature - Contractor's License No. Date
Permit Va .ati s Park Support Fee # $
Permit "-e $ /7 1 ei 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 $21,
/5
i
This Application Becomes Your Building Permit When Approved Pg
). 2 Z, / Receipt NO. /I 1611
�
Dae /r_ By
Building Official Date
t
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. Th.s 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