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0P% r. CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'ddTEMPORARY CERTIFICATE OF ZONING COMPLIANCE -en en AND UTILITY CONNECTION PERMIT i q,tx
44,„,esel
r I White File
2 NIA Cly 1 PERMIT NO./q . C,I4
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
3 �� ,E/2S/i/uy S-7--- /Q5 0
---14y
LEGAL DESCRIPTION(office use only) /�
LOT BLOCK ADDITION PID e9-S.‘
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OWNER / �Z (Phone)
(Name)
(Address) -1 L/ /P, /.5/0/?J
BUILDER ��
- (Company Name) 2%<C1V "'v/'-9// Cc"''.)-7 /� (Phone) !�/�-730 - 724/,7'
'(Contact Name) .� -/I/i? SCH/-r✓/, ) , /Z< (Phone) 4/7-7..30 -77 ' 7
(Address) 3/L)/ ?o,.'- C ,E 4S 7--
TYPE OF WORK 0 New Construction ❑Deck ❑Porch ORe-Roofing e-Siding ❑Lower Level Finish 0 Fireplace
❑Addition ❑Alteration ❑Utility Connection ''--yy o
CODE: ❑I.R.C. ❑I.B.C.
ig Misc Re0 l rS 4- k ,Ar cit.,
Type of Construction: I II HI IV V A B PROJECT COST/VALUE $
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5
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 of authorized agent for the
above-mentioned property and that all con iction 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,revekn this unit for It. cau urthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections
C
i\i
G ✓ '� s /Signatu �'—' Contractor's License No Date
Permit Valuation / S V Park Support Fee # $
Permit Fee $ /(!-' ,IN SAC # $
Plan Check Fee $ Water Meter Size 5/8"; I"; $
State Surcharge $ 5` 0 D 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 I $ TOTAL DUE $ /5{ ' 5•
ion B Aomes Your Building Permit Wh Approved IIIIAlir
Paid
167,soReceipt No.
Date 5-2.0 . lc( Receipt
, AAI-A/� ."ding Official Date
This is to certify that the request in the above application and accompanying documents is in accoidance with the City Zoning Ordinance and may proceed as requested This document
when signed by the City Flannel 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 Prior Lake,MN 55372