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F PR/ CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� `' TEMPOR CERTIFICATE OF ZONING COMPLIANCE
�'` t x AND UTILITY CONNECTION PERMIT
Mi I. White File PERMIT NO
3 Pink City ink l
3 Yellow Applicant
(Please type or print and sign at bottom)
Di
` ADDRESS ZONING (office use)
6o / 3 /Sd S .
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER W /
(Name) g C / /s �'"7 (Phone) 7 ` 2 7 /
(Address) love f�'C/ 7L S/ ' S•C---
BUILDER - /�
(Company Name) /�4'• -.' `24cae,.- (°1,414.2'0-. LL'' ` (Phone) 4'c 2- — '/ 1 3:
(Contact Name) /24- -4,4 `I (Phone) er t SZ - 2 — '''T
(Address) a 2 3 7 • S , Z-414, , Z CI., pi.4.4- 53-z9y
TYPE OF WORK ❑ New Construction ['Deck ❑Porch ❑Re- Roofing [Me- Siding ['Lower Level Finish ❑ Fireplace
['Addition ['Alteration EUtility Connection
CODE: R.C. ❑I.B.C. ❑ Misc.
Type of onstruction: I II III IV V A B
PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5 1
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 1 am the owner or authorized agent for the
abov ' Taloned p nd 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
oral can revoke this permit just c tse Furthermore, I h . y ee that the city official or a designee may enter upon the property to perform needed inspections.
T 205 ! Z1t 9
K ... i Signature Contractor's License No. Date
Permit Valuation -7.-cx74(3) , - Park Support Fee # $
Permit Fee $ Z41-_7 SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ (. 2 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 Fee / $ TOTAL DUE $ •Z
Thi: !" J n Becomes Your Bui Permit Approved Paid LP Recei. t No. �� wL�'
� � Date 4711 B �A
Buildin Ufticia D to
This is to certify t atuest 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 Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372