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(1 + CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
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TEMPORARY CERTIFICATE OF ZONING COMPLIANCE p' 7. /
X AND UTILITY CONNECTION PERMIT / /
l
A'INNES'S°P I. white File PERMIT NO . /�
Pink City l icant / }/J ��
3
Yellow Applicant
/ (/ �7
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
32_7(0 5(10.19/1612-6 � lL_ letso
LEGAL DESCRIPTION (office use only) ` /
LOT 2- BLOCK / ADDITION VA/ / O/V PID z5 /1/. 00 2 - 0
OWNER L L
(Name) P/ V& / L '/
A L /U ° V (Phone) .qg ' ND -/o-P-0
(Address)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ['Deck Porch Re- Roofing ERe-Siding Lower Level Finish ❑ Fireplace
❑Addition ['Alteration ❑Utility Conn tion
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II HI IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COST /VALUE $
(excluding land)
Division: 1 2 3 4 5 i
1 hereby certify at I have furnished information on • •plica .n , hich is to the • . my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above -mentio d property and that all constructi• will co for �
.: exist[ . d local laws and will proceed in accordance with submitted plans. I am aware that the building
official can r. oke this for just cause Fu - hermore, 1 a.ree at th�": ial or a designee may enter upon the property to perform needed inspecti
i ° t �C /4t- - /4 ) P_ Q l(
OSEMP W ` Contractor's License No.
air
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 $ 77 7
i
This Application Becomes Your Building Permit When Approved Paid 7 6 /. ZS R ipt No. 6376 67
Date l' 7,t/
/
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. 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