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F PRlp CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
44
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� X AND UTILITY CONNECTION PERMIT E6(2.:7.
���'NESO1� I. White File2. Pink City PERMIT NO. //.../, QQ/
3 Yellow Applicant
ase type or print and sign at bottom)
ADDRESS (-4Z 70 Wel' r ,vL= ZONING(office use)
a/5 D
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID c::)-53-'-(423'
O k.) ` a
OWNER
(Name) (Phone)
(Address)
BUILDER �F$404143
�� �-'tS L
(Company Name) ?t i Coi. . LLC (Phone) q.5-2-18,s.- rya
(Contact Name) Look 1<)" (Phone)
(Address) 2.1(.c3 CeAr Ave. LaIce 41L_
TYPE OF WORK ❑New Construction ['Deck ❑Porch Ze-Roofing ❑Re-Siding ['Lower Level Finish ❑Fireplace
❑Addition ❑Alteration ❑Utility Connection
ODE: ❑I.R.C. ❑I.B.C. ❑Misc.
e of Construction: I II III IV V A B PROJECT COST/VALUE $
pancy Group: A B E F H I M R SU
(excluding land)
ivision: 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 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 it for just cause. urthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspe tions.
X 63S'63q 8 Z? 2o'tf
Signature Contractor's License No. D
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 $
This Application Becomes Your Building Permit When Approved Paid Receipt No. :\.i, ci
Date By
Building Official Date
1111 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
n 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 Prior Lake,MN 55372