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oF PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE � p, / � /
.. � AND UTILITY CONNECTION PERMIT
U �
~�A'NE50�� � Wh��e File pERMIT NO. /
2. Pink City a
� 3 YelVow Applicam j
Please or rint and si at bottom)
ADDRESS � y ZONING (o�'ice use)
r ; ;i. . � � � � ''i �1,_�; (.. ? , „>
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LEGAL DESCRIPTION (oflPice use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
BUII.,DER /�//
(Company Name) / � ��� �- �J � ^c - (Phone) 76 3 - 2 o Z - 6 346
(Contact Name) � �. .� �• �. ` ��„�4 (Phone)
(Address) �( , � � �e � { �� � S 3v 2
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofin ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Con tion � � ( � �'r"
u f� �
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Consmiction: I II III IV V A B pROJECT COST/VALUE S
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 fiimished mformation on this application which is ro the brst uf my knowledge true and correct 1 also certify that 1 am the owncr or authonzcd agent for thc
abuve-ment�oned prope�ty and that all construction will conform to ail existmg state and local laws and will proceed in accordance with submittcd plans. I am aware that the buildmg
�.ifficial can revok his permit for just cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perForm needed mspections.
X G— ? 0 3 2� S 1Q- j�f -l/
Signacure Contractor's License No. Date
Permit Val ation 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 DiJE $
This Application Becomes Your Building Perntit When Approved Paid Rece t NO.
Date , B
Buildina Utlicial Date
Th�s �s to certify that the requcst in the abuve applicanon and accompanying documents is in accordance with thc City Zoning Ordinantt and may protted as requcsted. Th�s document
when signrd by the City Planner const�tuus a tempurary Certificate uf Zoning wmpliance and allows construction to commence. Before uccupancy, a Cernficate uf Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noficc for All inspections (9S2) 447-9850, f�x (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372