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oat.fPRl3' CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd4+ TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
Z.;
AND UTILITY CONNECTION PERMIT I do,. ici
*INN ES01t
1. White File NO.T PERMI
2. Pink City
(Please type or print and sign at bottom) Yellow Applicant ��a(�l J Z I
ADDRESS vvv
�— /cl )` ( ZONING(office use)
</Otr..,t. L......-G J� ��C, 2 �j24/ s•c—'
LEGAL DESCRIPTION(office use only) �I
LOT BLOCK ADDITION /�
PID `` ' CO3` ti-/
OWNER /' e ( '' "
(Name) .tel l �,o
7 ! (Phone) ic .r�J q Y 0" ?36 7
(Address)
BUILDER •
(Company Name) ei•-•.a-t4 - -c I (Phone) rit)) 6 V^ 6,Cl n
(Contact Name) / P( 7-e-t s (Phone) 1. S'81 0 �Y y
(Address) l a / li'-
.)-7 7 'Ce i 4......4._ f. 8�.�.f'c,-/e,� - 3')1
TYPE OF WORK 0 New Construction
DAddition Dater atio❑nDeck ❑Porch Re-Roofing DRe-Siding DLower Level Finish 0 Fireplace
DAlt ❑Utility Connection
CODE: DI.R.C. DI.B.C. D Misc.
Type of Construction: I II III IV V A B
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have hirnished information on this application which is to the best .. •-
above-mentioned property edge true and correct. I also certify that I am the owner ora that
agent for the
P P tY a •nstr ction will conform to all ate and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke this.i urthermore,I he--: -gree that the city official or a designee may enter
upon the
P property to perform needed inspections.
X ft c— 6 3 f(/03 7//6//
Signature
Contractor's License No. Date
Permit Valuation Park Support Fee #
Permit Fee $
$ 741, 7 SAC # $
Plan Check Fee $ , Water Meter Size 5/8"; 1";
State Surcharge $ ' C,0 Pressure Reducer
Penalty $
$ Sewer/Water Connection Fee # $
Plumbing Permit Fee $
Water Tower Fee # $
Mechanical Permit Fee $
Builder's Deposit $
Sewer&Water Permit Fee $ Other
f $
$ TOTAL DUE
Gas Fireplace Permit Fee
$
This Application Becomes Your Building Permit When Approved +'��`� �� ''.7/13/:-3
l `
Paid , Receipt No. ! 3/:-3
Date 7.a, /Li I By ,SGK4.4.) I
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
24 hour notice for all inspections(952)447-9850,fax(952)447-4245 Special Conditions,if any
4646 Dakota Street Prior Lake,MN 55372