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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
4,/kez.
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
r NNES ° ��
I. White File PERMIT NO . J^
2. Pink City Z r �LJ. -t! )
3. Yellow Applicant _ � l.J
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
�O Haie 9 SE 1 Priv Lake, /'YIN 5537? —
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) IA/4)7/1i �f f ex Meyers (Phone) 9,52 -'/%'t - ?614
(Address) 5() t-to Hope, St SE 1 Prior Lake M N 55372_
Rum-DER CO NTRAcTolt_
^ //�1 ,,, a
(Company Name) San db u, lAVl5 I y f U.C-I1 OC r t o Jr c- (Phone) 932 -q03 -9/
(Contact Na Ke
Name) e ii/1 SdrlcL 4k (Phone) 6/2 - 36 3 - 01 )-o
(Address) m 25 1.y110i alC Ave 3 [31oo 1111v1st271 -._ ra.) 55M'
?
TYPE OF WORK El New Construction ❑Deck ❑Porch ❑Re- Roofing 2e- Siding ❑Lower Level Finish ❑ Fireplace
['Addition DAlteration ❑Utility Connection (�
Kesi 41hs -4aW 51) if tidi re� il st t of h vn i r1V
CODE: ❑I.R.C. ❑I.B.C. Misc: I
Type of Construction: I 1I III IV V A B
Occupancy Group: A 13 E F II I M R S U PROJECT COST /VALUE $ i<5573.
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 c e this per 't for jus se. Furthermore, I hereby agree that • e c' official or a designee may enter upon the property to perform needed inspections.
X i /L .i y _ 7- . , / ;6'6072,5 t- /S /1,--
Signature / i� Contractor's License No. Date
7 j
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 i / $
1 i I (/
This Applica . Becomes Your Building Permit When Approved Paid / L7, 11 eipt No. (D C'L }'
Date c
i (i, 21 l
i
B . ding 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