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q CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
„..., ANTEMPORARY CERTIFICATE OF ZONING COMPLIANCE
Q tri AND UTILITY CONNECTION PERMIT /�` �Z
rNNES0�
1.White File evii
2. Pink City PERMIT NO. 1 z 6 6
3.Yellow Applicant(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
lb137 Aloriti wood Ike6td Alto Pr,otLKe t9
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
(ONaWNER 13race, ttiie. r ot 4 (Phone) 6 iA/D 1 b`C if
(Address) I I d 1 110r-fhWOoct o&4 NUJ
BUILDER Wi
ff(Company Name) n!�n "i1 l.� 'S ? Ta9501 -7(Phone) Lii‘v -666 I
(Contact Name) To 4 y Co4l1a ita$ (Phone) 9s o2 'q°8-.41 SCCG(Address) 12. e295 Creed V te(.J � u
& e �jQVele)M� .1,5370
TYPE OF WORK 0 New Construction ['Deck ['Porch ❑Re-Roofing ❑Re-Siding ['Lower Level Finish 0 Fireplace
❑Addition ❑Alteration ['Utility Connection
CODE: ❑IR.C. ❑I.B.C. pr..: WYZ)CL 7 qfQc '/I'&?-tlof Construction: I II III IV V A B O 0
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ 3 b �� --
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I.. • .. us ed informati n ' 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-meado :and that all coon will conform to existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official o..,.+fLt:. 't for j ause. Furth. ..ore,I hereby agree that the cityofficial or al designee may enter upon the property to perform needed inspections.
��J _ /3C 41ftoS'7 f—/ f--/2.-
rgnature Contractor's License No. Date
Permit Val,ation Park Support Fee # $
Permit -- $ 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 / $
This Application Becomes Your Building Permit When Approved Paid i` 4( C�7 Re eipt No. (0 C C%0 4---...' -
Date 6, _ c 5t ( .- 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
ed.
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