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CITY OF PRIOR KE ,
I TEMPORARY CERTIFICATELAOF ZONINGBUILDING COMPLIANCEPERMIT5Date/9Rec/'d
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AND UTILITY CONNECTION PERMIT
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1.White Cit PERMIT NO. /y
2. Pink City /D. /1 ?j yJ
3.Yellow Applicant V✓(/ [[//
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
51C.1 CFNoSSA,v0124., Sr. SL, PRioR L-.a.k-*, AA4 55312
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) JOH/J t`i a t212y (Phone) q52-L40-2 302
(Address) n(q CROSS AINDRA ST. GE, Pio LAkk, Mk! 372
BUILDER 1ME K COQ '1-17,UCTlON r,,
(Company Name) �r' (Phone) "I'J�'8c�gR' 2,�
(Contact Name) VE 12.12.\( \MA1.94 �y- �/ c� / `' r ((Phone) `1 GJ2.' big' I ZOO
(Address) (1555 JAMES DCVI G. �t G Zh.b E)�MiNu1IV,►VlN1, ;514.31
TYPE OF WORK ❑New Construction ['Deck ❑Porch 2fRe-Roofing ower Level Finish ❑Fireplace
['Addition ['Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. [ 'Misc: WINDOW S
Type of Construction: I II III IV V B
Occupancy Group: ABE F HI M SU PROJECT� $ 3D12:2.
O12:2. .L1
Division: 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 per t for just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X K.Wa( ,, # ZO(b444o2..-
Signature Contractor's License No. DjIb
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ 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 $ '7(o Q 0
This Application Becomes Your Building Permit When Approved Paid 7( - 02) Re t No. 6 031-7
Date S. . /?., (c B .
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