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s� CITY OF PRIOR LAKE BUILDING PERMIT, J / Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE v
ANDTU ILITY CONNECTION PERMIT
KESJ
°
I. PinkWe File PERMIT NO./Z /0 04__2. City NO./
z.
Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
iq 130 U0-6rci OMI tkg-
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITIONPID
OWNER � S
(Name)
C/N,1M - (Phone . 1. 20 - .
(Address) l y)30 t,W 'llatil
N t
BUILDER �" i V-10
(Company Name) 1).JCS3C �i/rl_,,, Jt"XlU•(:P�;LLL 1-V' 17`Y3�9 2.2-5-
(Phone) 660 2-Z- 7-61;-?4
(Contact Nam- �v jr t )� ' Vkk QQ (Phone)�b3) L2 6,5-?"
(Address) d!.'49) 1�' P1 It_ (90 kei 4-7S, 4-tkpo d Lk(l✓VVI.)
TYPE OF WORK 0 New Constru n ❑Deck ❑Porch ORe-Roofing ORe-Siding ❑Lower Level Finish 0 Fireplace
❑Addition Alteration ❑Utility Connection
CODE: \O A/Uly,- re ) 1 i`!J �c.--(tn ea
QI.R.C. OLB.C. fisc: '� Sol t. e.(n t fertc2 rt„lJ f
Type of Construction: I II MTV V AB
-
cv
Occupancy Gtuup: A B E F H I M R S U PROJECT COST/VALUE $
Division: 1 2 3 4 5 (excluding land)
I hereby cuff at I have famished information on this application which is to the best of my knowledge true and correct. I also certify thatmit am the owner or authorized agent for the
abovemen e pro etty th 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
°fruitl c rev e u perm' for cause. Furthermore,I hereby agree that the city official ora designee may enter upon the property to perform needed inspections.
Signature Contractor's License No. Date
Permit Valuation Park Support.Fee # $
Permit Fee $ SAC # $
Plan CheckFee $ Water Meter Size 5/8";1"; $
State Surchld OCCe detectors shaY1 he II Pressure Reducer $
Penalty as per there uireirhe pg'ade( Sewer/Water Connection Fee # $
9 ntsofthelRC
Plumbi����llt the house. BatteryWater Tower Fee # $
lie I'1� opera Builder's Deposit $
Mechani y be iryctalled in
Sewer&Water Perm>eR¢gtjng StAictures Other $
Gas Fireplace Permit Fee $ TOTAL DUE
f $ r�fj, 7-5
This Applt ,o,Becomes Your Building Permit When Approved Paid /s79, /3 R ce. t No. (Q/�s 9el r
_ 6 , 31 . ( 2_ Date .5/_ , B
Rig Official Date
This is to c : 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