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of PRI CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
- x AND UTILITY CONNECTION PERMIT
U t r j
M'N'NEse: i. White File PERMIT NO.
2. Pink City
3 Yellow Applicant 'e '
(Please type or print and sign at bottom)
DDRESS ZONING (office use)
/ 4/ r , Si- fid Ate . r. 6
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
X OER /�, i /
(Name) V��l� ? 141-4-1,0/ � �' " ` f (Phone)
(Address) SGm 4 gS , Jo
UILDER
(Company Name) , j'7a'k / C �� (Phone) � — 6 j G ' / t (Contact Name) CAA. !%t � / 4 + S� �•- (Phone) 4-(
/gyp/ Al-4_ f
(Address) 686 t" /51., , i v' 7 car- 4 t-e. Art? — 7 2
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ®Re- Roofing ❑Re- Siding ['Lower Level Finish [=I Fireplace
❑Addition ['Alteration ['Utility Conne ion
CODE: $,R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II HI IV V AB PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
N 1 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 revo s 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 4 3 'I lo( 7 / /s //o
Signature Contractor's License No. Date
Permit Valuation 5` r' . Park Support Fee # $
Permit Fee $ 1 I k 1 J SAC # $
Plan Check Fee $ J 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 Permit Fee $ TOTAL DUE $ 16,, •
This • , "r ati Be , es Your Building Pe?mit Wh: Appr ved -- Paid ?Cop Receipt No. 5 7 O
Al Date s65-- I p By, ei� 3k,
B AEI= O
This is to certify , : 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