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o l ' PRIOR CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
\ TEMPORARY CERTIFICATE OF ZONING COMPLIANCE /G 3f,, I/
- AND UTILITY CONNECTION PERMIT
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1. white Pile
2. Pink City PERMIT NO. it f f (a 5--
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3. Yellow Applicant r
(Please type or print and sign at bottom)
ADDRESS • ZONING (office use)
/s' /, , ,< - K
C *)/ itS CO 11PQ.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
((Name) Z----; (j }1 A A- 1 p'f Ve__ (Phone) 6l Z=390 2
(Address) g \__e_
BUILDER r,�(/
(Company Name) , _C uiv b' u ATV 'c CC)h n- i," l l un (Phone) 71' U - 7K6 7
(Contact Name) _ r� �� S (Phone) �.2- Z rz -,� 9,3---?
(Address) / 6g1 j (ilJ e- 1 Cc-) p-,,<- A _ Pt' / Ov= ( (- L
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ,d - Roofmg ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connecti
CODE: ❑I.R.C. ❑I.B.C.
❑ Misc:
Type of Construction: I II III IV V A B
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I : ve 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 p rty 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 revo ris permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X . D --- YS 7 — ) / - 3% - 7(
Signature Contractor's License No. Date
Pe . aluation 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 $ 79: 7r---
L
This Application Becomes Your Building Permit When Approved Paid Z / 7 Re ipt No. ( ��‘ 7
Date _ e _ < 2 4 „ , _ _ 4 (
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 I3efore occupancy, a Certificate of Occupancy must he
issued.
Planning Direclot Dale Speu.d Conditions, if am
24 hour notice for all inspections (952) 447 931511, fax (952) 447 -4245
4646 Dakota 5h-eel S F. Prior Lakc, N1inncsota 55372