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CITY OF PRIOR LAKE BUILDING PERMIT Date R
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TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT — 40
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t. White File PERMIT NO. • 777
2. Pink City 11�111��1111 11 �j� 0,.,5- 1"/
3. Yellow Applicant h .,
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
' 5 CO aq U nD IC ' Pd SC, Pn oY Lai -e IT) N .5".)?).
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNE 'I
(Name) 1 J C'Ci I. \ , doLt (Phone) ` T i I - 1 I
(Address l l.� e& . ` I i 0 r y, e 1 1 I N f :
BUILDER �i ( Q I
(Company Name) 1W1 K t� C� 1L�l�t 5.j °a -cam . (Phone)C2 2), -1 S 4' 'a Le LI- 6
(Contact Name) -J (Po e I - g `1 mo �P
(Address) 147 y . c "'i,,,ut, XP2a.. 1 iv Sco )4 ,u y `ustomremodelersinc.cor .
TYPE OF WORK ❑ New Construction ['Deck ❑Porch ❑Re -Roofing ❑Re- Siding ❑Lower Level Finish ❑Fireplace
❑Addition DAlteration ❑Utility Connection
' CODE; Di.$.C. DLB.c. N Misc: l�.>I ►ll j3Lj\ ci l h C i nn -
Type of Construction: I II III IV V A B J
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ 1 :1 ao 00
Division: 1 2 3 4 5 (excluding land)
thereb certify that I have fu hed 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 -me do ed property .... . at all construction will conform to all existing slate and local laws and will proceed in accordance with submitted plans. I am aware that the building
official voke this pe . o r lus cause Furtherm I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X 00 ' ' 7 (- / � O? ) Ig 41 1 3
Si e Contractor's License No. Date
Permit Valuation ( /// I I I 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 $
This Application Becomes Your Building Permit When Approved Paii �\ L `L(:� 1 f ?, �� By Receipt No. (0 �O
Dat \E 2- ttt ii Y Z 1 .j A--
`J l �
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
issued.
Planning Director Date Special Ccnditicns, if any
24 boar notice for all inspections (952) 447 -9850, fax (952) 447 -4245
1646 Dakota Street S.E., Prior Lake, Minnesota 55372