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,1., CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
�jNo.�
AND UTILITY CONNECTION PERMIT Taj- )4
2.White File
PERMIT NO. /7'`4/ li 7
e type or print and sign3. Yellow Applicant 7
at bottom)
DRESS
5/ 1 D I5(�+K 3+lceel ZONING>
LEGALDESCRIPTIONDESCRIPTION(office use only) / p
LOT 1 BLOCK / ADDITION .S / s't -4?-4,64/ PID 075-- ,2R7-- oD f-D
OWNER Uaye h 1. 6' 1 o (�i s 1 (Phone) j:01_ -_ _q)(-(---5.
7 (-( 5 8-87
(Address) (57 I D I -L1 SA- E Vr‘U( 1ii1 kQ j MN S5-3-o-.
BUILDER •
`j p� 4-7
(Company Name) A A tl♦ ,..(11, (Phone) 1
(Contact Name) ' t • (Phone)
(Address) 5t6b V v )ItiWk qi‘rctuet o Y ' `v S' Sca
TYPE OF WORK 0 New Construction ['Deck ❑PorchIdRe-Roofing ORe-Siding ❑Lower Level Finish 0 Fireplace
['Addition ['Alteration ['Utility Connection
CO•DE: DI.R.C. DI.B.C. 0 Misc:
Type of Constitution: I II III IV V A 13
cupancy Group: A B E F H I M R S U PROJECT COST/VALUE $
vision: 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 't for just cause. Furthermore,I.ere agree that the city official or a designee may enter upon the property to perform needed inspections.
X it /._i40 �: a 1 9 rl
Signature Contractor's License No. ate
Permit Valuation Park Support Fee # $
Permit Fee $ SAC ## $
Plan Check Fee $ gliti
o - 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 $ riq., r/�/J
c
This Application Becomes Your Building Permit When Approved Paid()IL // q r �� Receipt Noq . 7, 9 . /7 U
Date t By 1
s4, 5--2
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
en 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
d.
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