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° pRt `pCITY OF PRIOR LAKE BUILDING PERMIT,
Date Rec'd
t'! '3; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
�� (.. 2/it-27 AND UTILITY CONNECTION PERMIT /f 2l`t`NES / V. ��
I.white File I PERMIT NO. s /erI
2. Pink City tlO
(Please 3.Yellow Applicant
type or print and sign at bottom) pp
ADDRESS t( .L\010
�t5e. t/-IcAl cl w ZONING(office use)
?c\Ur \ot\se TNN - SS3-1 Q\ r
LEGAL DESCRIPTION(office use only)
LOT BLOCK V ADDITION 5 11,e'e 17C.„ PID& !,r/ �,'0,42 -- O7/
OWNER
(Name) S\'eec1 \=c,.,c-.\t-tc‘c\ (Phone) 'ASA-3S3-LI$d0
(Address) I(04c10 fit. k.... Nt i\vo Qc civ \ctKe , cc\cx SS3'1cl
BUILDER
(Company Name) EStt.\jer\ ' ,_.,<-\e'- tie- S (Phone) clSat - 1- l(cs\3
(Contact Name) \gin etlpe\5c.)y-‘ (Phone)
(Address)4S'Co 11 RiCc)\ke\ awe S CS\co th\nc) tc •c iNC\ SS-Ia c,
TYPE OF WORK 0 New Construction ['Deck ❑Porch ORe-Roofing['Alteration ['Utility
ORe-Siding ['Lower Level Finish 0 Fireplace
❑Utility Connection
ODE: ❑LR.C. ❑LB.C. amisc: W'�c t)W t—e \G�� c\ a e�-i
Type of Construction: I II III IV V A B Q `���
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ \C j S
o
Division: 1 2 3 4 5 (excluding land)
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-mentioned property and th. ,.. co... :•. will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke this pe ' '.r jurthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x � t2- c.00(4.s'6Lt -A-aU-\5
Signature Contractor's License No.
Date
Permit Valuation Park Support Fee #
Permit Fee $ / SAC
# $
Plan Check Fee $ n
�` ater Meter Size 5/8"; 1";
$
State Surcharge $ �) Pressure Reducer
VV "" $
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 '': K/�
This Application Becomes Your Building Permit When Approved
f-/• Z
75'
I Receipt No. �j'GS
• By ! I
I ate
Building Official `� J
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