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((i ,PRIo CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Q.........„
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AND UTILITY CONNECTION PERMIT ( a t Y� /1
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.'kNES011* I. White File PERMIT NO. L/ [// //J_
2. Pink City ( r // //)�
3 Yellow Applicant r iii 111 ��,LLL!!/GGG///
se type or print and sign at bottom)
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DRESS ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID c9S • 7U .0 , 4O
OWNER t (
(Name) ti Wk 1�G \`�{- (Phone) Y 52-- 9-5 Z^ 36 D e
(Address) 2.- sl 0 CIfU4 N PPlD4' L-..._.Vv- Iv1 JS-37 7.--
BUILDER 5
(Company Name) 1tn 4 -1L -0 \ e$C � (Phone) 7( - -3/5 --O 7t 5
(Contact Name) 1\A‘c �
� , z-a ` J 11
k-5 ..+--. Z(Phone) t $— `-f Z este-
(Address)
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(Address)/0550 Co /Q-1(/ cF/ (0 My /- __ (',c 0,p-2. /14 IJ 3 6,
TYPE OF WORK ❑New Construction ['Deck ❑Porch :Roofing ❑Re-Siding ['Lower Level Finish ❑Fireplace
❑Addition ['Alteration ❑Utility Connection
CODEC. ❑I.B.C. ❑Misc.
e of Construction: I II III IV V A B PROJECT COST/VALUE $ 2-3. ^—
4iou
pancy Group: A B E F H I M R S U
(excluding land)
ision: 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
above-mentioned property and that all co uct in 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 this. -mit for just c". Ft J ermore,I hereby agree that the city official or a designee may enter upon the property to perform needed i pections.
xG ` I _ 6cee2- 9, f417 20 <b (
Signatur:f Contractor's License No. 'Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ <J� Water Meter Size 5/8"; 1"; $
State Surcharge $ . ) 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 $,,./
i
This Application Becomes Your Building Permit When Approved Paid ! �� Receipt No. 701 5?3
Date (0, i ( By , 514..-4-)
Oilt•OI {Ty 10.(i (fir
Building Official Date /�' l
J` .' 11666
I /itJ,q 1�-11r�, (tati 1 q'f/Z
is to certify that the request in the above application and accompanying documents is in accordance with e City Zoning Ordinance and may proceed as requested. This document
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
D
d
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