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01 PR/04.
CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
U TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
1: AND UTILITY CONNECTION PERMIT
—
t.White File
?. Pink City NO. .�PERMIT i 2 ( ^..JJ17
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
351 I hicct,aa0 C,i ie 5 ) Moe/A&` Ft 4J 5537a
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER // �r,,n
(Name) U f'v '1O (Phone `152)x'4-3350
(Address) 3591 8/9556Jx'b /2 Si...) ke to G17 /49/v/ 5' 7c2
BUILDER ,
(Company Name) GJ /EL "G-mid M.,,E �,elp' 45 (Phoned)933 -6300
(Contact Name) /Ay Di&(6s/E-01) (Phone)
(Address) 33 ' 146901 / 577 65, if , ,ilii/ 5'S4/a'
TYPE OF WORK ❑New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace
['Addition ❑Alteration ['Utility Connection / ,.� �
CODE: ❑I.R.C. ❑I.B.C. , Misc: �( 04-46 111 lam/
Type of Construction: I II IIIIV V AB ( IS Tr/t'97"-tAl9 OP6yvt 5 e
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ 31 76.-3,
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 r ke rmit for just cause. Furthermore,I hereby agree that the city official or adesignee
�jmay
jenter upon the property to perform needed inspections.
R Cor44e7`, / 6–/a2/?.
Signature Contractor's License No. Date
ke P
Permit Valuation t>7 C 6 Park Support Fee # $
Permit Fee $ 4S!.,,Z.)4
A ,S SAC # $
Plan Check Fee r c,e. 0\sb Water Meter Size 5/8"; 1"; $
State Surcharge O $�PJ� �(, ,fiS�� Pressure Reducer $
ti
Penalty G`9 ,44$ ,.,z, Noe' ScG Sewer/Water Connection Fee # $
Plumbing Permit Fee b t��,� ,S,fi�� c,., Water Tower Fee # $
Mechanical Peryi:e' , �'� `'� �$�� � Builder's Deposit $
Sewer&Watericsii.. . ,e.; Sco'C Other $
Gas Fireplace Pert u� S e TOTAL DUE $
07
This Applicati nBecomes Your Building Permit When Approved Paid / 7 -7 r Receip o. u/(G"2-J' 7
At:
(S.. 7 1 .. (7------- Date &. 2i/ / Z— By .
But ing 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