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oF pR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� ' AND UTILITY CONNECTION PERMIT � � � � � Z `
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'yjA,NE$�t�' I White File pERMIT NO. JJJ
2. Pink City
3 Yellow Applicam � + �
Please e or rint and si at bottom)
ADDRESS ZOIVING (of�'ice �se)
. � ,��` �� �
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER ;� � ���� �, fi - (Phone) �6 .3 3 ?C� c�0 7S�
(Name) / J V'✓��
(Address)
v c�c�l
(Company ��� r�- eS fd��c rt� o� �r/�cJ� (Phone) ( j Z � 7� Sd �CJ
(ContactName) �-�v�lc�. �� ll eS„�!i'� (Phone) �S�L - .37��5���
(Address) ? , ( fj e- �/ 0 ,3
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �e-RooFing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. 0 Misc.
Type of Construction: I II III N V A B pROJECT COST/VALUE $ l �Do
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 Z 3 4 5
I hereby certify that I have famished mformation on this application which is to the best of my knowledge mie and correct. I also certify that 1 am the owncr or authonud agent for the
abuve-mentioned pr perry and that a onstruction will conform ro all existing state and local laws and wil( proceed in accurdance with submittcd ptans. I am aware that thc buildmg
official can revok is permit for ju u e Fm7 � re, I hereby ag, e that the ciry official or a designee may enter upon the property to perform necded mspec ons.
X ,- . �L Zd6 .37�3 2 S� l z
Signature Contractor's License No. Date
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 $
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This Application Becomes Your Building Permit When Approved Paid Re ' t No.
Date B
BuilJim� Utlicial Date
This is to certify that thc requcst in the abuve applicanon and accumpanying documents is in accordance with the City Z.�ming Ordsnantt and may proceed as requcstcd. This document
when signed by the Ciry Planner consumtes a temparary Certificate of Zoning compliance and allows consrruction ro commence. Befure occupancy, a Ceruficate of Occupancy must be
issucd
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Planning Director Date Special Conditions, if any
24 hour noticc ior ail inspections (952) 447-9850, i'ax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372