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�I PRI() CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
I AND UTILITY CONNECTION PERMIT q_ Z I,. /
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• 4f1NNESOlr I. White File PERMIT NO. //3b
2. elCity ��'
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS / ZO�NjI`NG) (office use)
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LEGAL DESCRIPTION(office use only) `
LOT / (BLOCK ?--- ADDITION 5A-/UA 43,, ]) .j fr--d PID R� Z/V-(.9,/ d
OWNER ,-- -/ �1 r
(Name) S�y� 40th $b e (Phone) 9iJ od-�/lv"D�d /
(Address) /1/107,.? eedzemzer et,r4 /(fir
BUILDER /
(Company Name) /ilgi4 ti ,tMc iS OfO/i17/tee (Phone) eSi- a.$-a/Or
(Contact Name) �i/( Atit_A 4$s L (Phone) (A) _
(Address)0,EGI4 ,c71; S/ igez ii - N 5f/07
TYPE OF WORK ❑New Construction ['Deck ['Porch DRe-Roofing ORe-Siding ['Lower Level Finish 0 Fireplace
❑Addition ❑Alteration ❑Utility Connection 1t I `)
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cb 00
CODE: ❑I.R.C. ❑I.B.C. ❑Misc. V�
pe of Construction: I H III IV V AB PROJECT COST/VALUE $ l6rSg.<
cupancy Group: ABE F HI MR SU
(excluding land)
ivision: 1 2 3 4 5
I hereby cert. t I . fu . fed i 'n'mation 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-men pr.. a that .. construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official c e , ••per,, • - Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X ide/4,3vc3'
940c-
Signature Contractor's License No. Date
Permit Val i ation Park Support Fee # $
Permit Fee $ SAC # $ I
Plan Check Fee $ < Water Meter Size 5/8"; 1", $
State Surcharge $ Pressure Reducer $
c
Penalty $ ��" Sewer/Water Connection Fee # $
Plumbing Permit Fee $ r t Water Tower Fee # $
Mechanical Permit Fee $ l Builder's Deposit $
i
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ ✓r.
/75/7
This Application Becomes Your Building Permit When Approved Paid 1< Receipt No.
Date q
o
7 1 S� By 5
L
Building Official Date
iihis 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
en 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
ed.
Planning Director Date Special Conditions,if any
24 hour notice for all inspections(952)447-9850
4646 Dakota Street Prior Lake,MN 55372