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eITV OIl' llllIOll Lurn DUIlDINC DEWIT
TEMPORARY CERTIFICATE OF ZONING COMPL'IANCE
AND UTILITY CONNECTION PERMIT
Date llec ~ d
5-.~. OK
White
Pink
J Yellow
File
City
Applicant
I PERMIT NO'08. 030/
(Please n at bottom)
ADDRESS
ZONING (office lIse)
162. rcr PIf'k Vr'f 4..- f)/l.
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
(Phone)
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address) 7He;- ,0 ?u~,Z-
{looP Co~/J4~y ,,(./;4
{/.J I~ ...,/lOt-
t>""-L
(Phone)
(Phone)
~<$o/(J
61'2- 70 'J.'? ~r7
/J II ,
A-l ~ //t' 4.-4 A-..A--
TYPE OF WORK 0 New Construction ODeck OPorch -Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition o Alteration o Utility Conn tlOn
CODE: DI.R.C. DI.B.c. o Misc.
Type of Constnlction: I II III IV V A B PROJECT COST IV ALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: I 2 3 4 5
I hereby certity that I have turnlshed mformatHln lm this applicatIOn which is to the best of my knowledge true and correct. I also certify that I am the owner ll! authonzed agent tll! the
abovc~mentlOned property and that all constructllln will conform to all eXlStmg state and lllcallaws and will proceed m accordance with submltted plans I am aware that the bulldmg
offlcial can revoke tlm permit I,)r Just calise Furthermore, I hereby agree that th\:.9!Y_Q(fjcialllr a deSignee may enter upon the propelty to pertorm needed U1spccttons
(' ~-------
Signature
x
'):-2?-08
Date
Gas Fireplace Permit Fee
$
$
$
$
$
$
I $
$
Park Support Fee
SAC
#
#
$
$
$
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Water Meter Size 5/8"; I";
Pressure Reducer
Btlllctlllg Ut'ticlal
Date
Sewer/Water Connection Fee
Water Tower Fee
#
#
Builder's Deposit
Other
This Application Becomes Your Building Permit When Approved
This IS to certify that the request In the abnve applicatIOn and accompanYlllg documents is in accordance with the City Zoning Ordinance and may proceed as requested TillS document
when signed by the City Planner ClmstItutcs a temporal)' Certificate of Zonmg compliance and allows construction to commence. Before nccupancy, a Certificate of Occupancy must he
issllcd
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372