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O{ PRIO
i/"r .4, CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Date Rec d
U
AND UTILITY CONNECTION PERMIT /2. /-S-1 0,
1. te I PERMIT N
2. WhiPink File CityO. /��/ I
(Please type or print and sign at bottom) 3.Yellow Applicant 04..—
ADDRESS
S 3 ONING(office use)
l5
G✓//t�wo� d/%' 56 , Aoi2 G�Kc , 44,t/ .5537
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION
PID
OWNER /�
(Name) i�/Gha% /Ce'/e/'Sar (Phone) (tsfL) 615-793 o
(Address) 66,$3 t-'fiS t,.,oGS eiP SE /0,2/o,z. Gwe- 4f/1,I 553 7.2
BUILDER
(Company Name)
(Contact Name) (Phone)
(Phone)
(Address)
TYPE OF WORK 0 New Construction ['Deck
['Porch AZe-Roofing ORe-Siding ['Lower Level Finish
❑Addition DAlteration ['Utility Connection ❑Fireplace
CODE: ❑I.R.C. ❑I.B.C.
Type of Construction: I isc: %w - A tc- e n—
II III 1V V A B
Occupancy Group: ABE F HI MR SU
Division: PROJE T COST/VALUE $ g,000-
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 con . ction :.a. onform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can ke this 't for just c....e urth- e,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
Signa 1 re / 2//VIContractor's License No. D
Permit Valuation Z/ 5t—. U 0. 0 0 Park Support Fee #
Permit Fee $ SAC
Plan Check Fee $ Water Meter Size 5/8"; 1";
State Surcharge $ $
/. L Pressure Reducer $
Penalty $ Sewer/Water Connection Fee #
Plumbing Permit Fee $
$ Water Tower Fee # $
Mechanical Permit Fee $
up Builder's Deposit $
Sewer&Water Permit Fee $ Other
$
Gas Fireplace Permit Fee $ TOTAL DUE
This Application Becomes Your Building Permit When Approved
Paid /2 6.. 00eipt No. .5-5.2..2.7
Date /Z 4%2, 0? I �� J
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
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