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C} CITY OF POR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE //
2White <<� ( --�PERMIT NO.
. /
3 Yellow Applicant C /�/`y`%
(Please tyke or print and sign at bottom)
ADDRESS / / ZONING(office use)
LEGAL DESCRIPTION(office use only)
/i 1" —�
LOT BLOCK A ae PID 09574 0- ----606,_.
OWNER — -- - —
(Name) Ao`( Cv"O'N''' "Sq
(Phone) �fJ i Z'- 910- -S-2 3
(Address) /s7s-o 7 Ca , t✓. l-- 4SF ,A16--
" At Lice/
Aii A/
BUILDER —
(Company Name) (F C/1 e / �C (Phone) f
, 99.2_ - 7 sec- 3 O 5 C
(Contact Name) / C Cc– e
-?00 1 G L- at* pl� '��/� �� (Phone) �o/� - 517F-' Ca 8'�
(Address) � �f---
-..s.) , 1 (. , AN X533`7
TYPE OF WORK ❑New Construction ❑Deck ❑Porch ❑Re-Roofing e-Siding g � g ❑Lower Level Finish [J Fireplace
❑Addition ['Alteration ['Utility Connection j
CODE: ❑I.R.C., ❑I.B.C. D Misc.
-__ -- —
Type of Construction: I II III IV V A B /
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ / ®d
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information on this application which is to the hest of my knowledge true and correct I also certify that I am the owner in authorized agent for the I
above-mentioned property and that all construction will co 7rm to all existing state and local laws and will proceed in accordance with submitted plans I am aware that the building
official can revoke t i ust cati . Ft ermor , hereby agree that the city official or a designee may enter upon the property to perform needed Inspections
Signature
X S 51s--d.f631L
� to 1s"-
tr
Contractor's License No. Date
Permit Valuation
Park Support Fee t# --- T $-- ,
Permit Fee $ SAC # $ 1
Plan Check Fee $ to
Water Meter Size 5/8", I", $
State Surcharge $ ` _ —
Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
I
Plumbing Permit Fee $ Water Tower Fee # $___�_
Mechanical Permit Fee $ Builder's Deposit S
Otherer
Sewer&Water Permit Fee $ --— 7 $ _
Gas Fireplace Permit Fee I $ TOTAL DUE $ t 1
This Application Becomes Your Building Permit When Approved i -A.,- 4 q
_ Kecclpt leo / q--0
ate ; By 1
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 d,curne tit
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 --- Spe- -----------._.
cial Conditions,if any
24 hour notice for all inspections(952)447-9850 — — -
4646 Dakota Street Prior Lake. MN 55372