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00* poCITY OF PRIOR LAKE BUILDING PERNIIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCEx AND UTILITY CONNECTION PERMITy2Z- fs
vt.,
fa APANNEsOSt° I.White File PERMIT NO.
2. ell City 1��//
3 Yellow Applicants
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
36 / I Cross ,iJr4 s7 sE I 'ioA- L,
LEGAL DESCRIPTION(office use only)
LOT/0 BLOCK 3 ADDITION rt1, a1c 1 /4 d 91 i efd). PID d Cs34d03 5-0
OWER
(Name) 60 Ac'e (Phone) fele?, 5#O` 44,2?
(Address) .5-67 y I L'/'cyss4,4140- si 66, /not Alk
BUILDER I
(Company Name) M,I/S t'S /� ')l /le---- (Phone) e05/- 772^'l//
(Contact Name) O c& nNOrvs (Phone) (49/er' 75V - yam®
(Address) d 9 Y 0 CA qr kJ sr, N. 5.,;l ?1 ) No, 5i, ph,/ "I Sri
TYPE OF WORK ❑New Construction ['Deck ❑Porch DRe-Roofing Xe-Siding ['Lower Level Finish 0 Fireplace
❑Addition DAlteration ['Utility Connection
411;D
radM;sc./Seh1Cl)Z S�Crc e✓,...oNL � tA�- �ef/?C�
CODE: ❑I.R.C. ❑I.B.C. t- • 4
Type of Construction: I H III IV V A B PROJECT COST/VALUE S &/01°0s 1
Occupancy Group: A B E F II I M R S U (excluding land)
iivision: 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 agent for the
I above-mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
tot official can revoke this permit form se. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed ins etions.
X i 7At, 661,3'3 r�d3/,s
Signature Contractor's License No_ Date
Permit Valuation Park Support Fee # $
Permit Fee $ 71-75- SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ `ted 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 $ '1s• 7,-
This Application Becomes Your Building Permit When Approved Paid �J . 7r R Ipt No. Z-X/
Date 7 Z. Z, ,`—
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 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
iio
issued.
Planning Director Date
Special Conditions.if any
24 hour notice for all inspections(952)447-9850
4646 Dakota Street Prior Lake,MN 55372