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o f Pita CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
4.
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE /D. /Z
. AND UTILITY CONNECTION PERMIT
yIp NE S p'�� I. White File / /
z. Fink city PERMIT NO. ` L . ' Q
3 Yellow Applicant l / �( /
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
. .5 p Ski
/2( -
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) � rc 4 � eL Q CUff C -S (Phone)
(Address)
BUILDER /
(Company Name) / e i Q/� .5` 4 64 �ir� (Phone) c< '� (v
(Contact Name) 6- � i@ /#17 l (Phone)
(Address) Vj2/ O ' TTe L. / - L .
TYPE OF WORK ❑ New Construction ['Deck ❑Porch Re- Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
['Addition ['Alteration ['Utility Conn do
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II HI IV V AB
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $
(excluding land)
Division: 1 2 3 4 5
1 hereby certify that 1 . ve fu• 'shed 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
above- mentione• op d that all cons • ction 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 r • e th p. it forju t �,• rthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
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X A�I�� _r
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Signature Contractor's License No. ate
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 $ +79 7s-
This Application Becomes Your Building Permit When Approved Paid /C1_ 7 f- R ipt No. 6 4--z...62 (P
Date /U _/ Z 7( B
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