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OF PR1"o� CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
a TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
el I AND UTILITY CONNECTION PERMIT
LESOV'
I. White File I PERMIT NO.
2 PinkCity /3-1 oD
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS
ZONING(office use)l �{ 1 &tpti dot e MYt % pp' L( V-t
, Am) 2
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER tv � ya,� h/�
(Name) I A 1�. (Phone) .*1-260 0 D
(Address) ! qv I'5 U e kt le, eve ;,e
BUILDER //`��� .1n� (� /� p
(Company Name) CAO11 1 " t 1'� LO��t&1(1 Lai (Phone) a Cg-—2 " :Z7iT�0
(Contact Name) a li emiL h RS -2- 0 O
(Address) (41.61?� t,i1�e��,t.e S� (Phone) Z �� S 0
e P��r�v �.� , MnJ
TYPE OF WORK 0 New Construction bepeck ❑Porch ORe-Roofing ORe-Siding ❑Lower Level Finish 0 Fireplace
❑Addition
❑Alteration ['Utility Connection
CODE: DLR.C. DI.B.C. 0 Misc.
Type of Construction: I II III IV V AB
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ 9-600" 0 O
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information • ' ...lication which is to the best of my knowledge true and correct. I also certify that lam the owner or authorized agent for the
abov- ffYd property an. all ce n tetion w' onform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
rcial can revoke this permit f. .st c, a Fu.• ore,I hereby agree that the city official or a designee may enter upon the roe to
P property rtY perform needed i I'pectioss.
_` P. Signature AIL �� ,/ / �� I
Contractor's License No. Date
Permit Valuation Park Support Fee # $
400e. Od
Permit Fee $ 88 .zs. SAC # $
Plan Check Fee $ S7 " 36, Water Meter Size 5/8"; 1"; $
State Surcharge $ i , 5C) 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 I $ TOTAL DUE $ !y/�. I
This 'pplica on Be t- es our Building Permit When Approved Paid
Receipt�io. G�' 4. Z
/
Date By i
Bui ding .trial ate
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 reque;aed. 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