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of PR�o�P CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
A. e TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
7
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AND UTILITY CONNECTION PERMIT 0 . /6. /,i
44,„ESect.
L White File
2. Pink City I PERMIT NO. /5- 12,71
3 Yellow Applicant
ase type or print and sign at bottom)
Ilik
(DRESS /�.��`
1 f 1,� g/ J�`7 GC.- 2 PA'JO(L 4)Z A11 ,S5322._ ZONING
/ J (office use)
LEGAL DESCRIPTION(office use only) (�
LOT-7 BLOCK ,L ADDITION b/c:IA /De3Ac'J/t PIDa6; 47®7-05-2—0
OWNER ,, /� lel
_ /
(Name) �i4 Q GIU 3Q V 1 n S(�(1 (Phone) 7(,3 g77 O e37
(Address) I L)dt 13 & e 2 C Po_doz I k e 1 M` /V 55372
1 BUILDER f ��// l
(Company Name) PQM, S4j 2-I- Cons-t-2 4 G1ion (Phone) 7‘.3 -3 OS AD-59,
(Contact Name) 31 M, t.._ I2AQ. Tot IA k4 �+ / (Phone) 743 o7OS —sV
(Address) Iug5 ^s� -S� AL C CMp `1 ✓ -, 5:53/J
TYPE OF WORK 0 New Construction DDeck ❑PorchRoofing ❑Re-Siding ❑Lower Level Finish 0 Fireplace
CODE: ❑I.R.C.
DAddition
iii:u
❑Alteration ❑Utility Connection
❑I.B.C. 0 Misc.
pe of Construction: I II III IV V A B /,x
pancy Group: ABE F HI MR SU PROJECT COST/VALUE $ in,cot)
ision: 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 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
official can revoke this permikfor Just cause Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
1 X _______ ) 1/4-k.,;,I) ‘\1/0/.-\(\p_kh-k)
Signature Contractor's License No.
Date
Permit Valuation Park Support Fee # $
Permit Fee $ ^ C SAC # $
Plan Check Fee $ 1 I"I d l7 Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
Penalty $ „±„.....:„.......„..„...---------(3\-)
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 $ 15-'7_
This Application Becomes Your Building Permit When Approved Paid
Receipt Na
Date 0 c [/ _, /3 By
Building Official Date C�
IDis 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
dsigned by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
Planning Director Date Special Conditions,if any
24 hour notice for all inspections(952)447-9850
4646 Dakota Street Prior Lake,MN 55372