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oF rR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �
.. X AND UTILITY CONNECTION PERMIT �' Z ��
U �
bjNNESO�P �. Wn��e File pERMIT NO.
2. Pink City ! 2 ' � � �
3 Yellow Applicant /
Please or rint and si at bottom)
ADDRESS ZOI�TING (oFFice use)
��/L� � �,�I � :.5� ��p 7`� (.
LEGAL DESCRIPTION (oflice use only)
LOT BLOCK ADDITION PID
O a WNER �� /'` ��' � ic-K (Phone) �5�� - �6 ��
� / �
(Address) 6 b � d' /��vr �/` �. �;dr L�� Y'�/�.J
BUII.,DER /�, // ) ) �
(Company Name)/' I `l ,f T�/' �E'�'►J7"l'vc� � �v� (Phone) !��'� y7 9 ""�7� � - -
(Contact Name) C�c-� �.L�,r�f ���5�-•� (Phone) 6 � 2 - ` ZJV —/�.f _ 3
(Address) S� y� H ��1 � ^ � J �. r b �'( � /� �.� .� 9
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing e-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utiliry Connection
CODE: �I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III N V A B pROJECT COST/VALUE $/�/� O d
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that have fumished information on this application which is to the best of my knowledge true and correct. I alsu certify that 1 am the ownrr or authonzed agent for the
abuve•me ed operty and that all cunsU�uction will conform to all existing state and local laws and will proceed in accordance with submined plans. 1 am aware that the buildmg
official n r o this permit for just cause Furthermore, I hereby agree that the c�ty official or a designee may enter upon the property to perform needed mspecuons.
X � ���/S7 y t f-Z3 / Z
Signature Contractor's License No. Date
Perrr►it Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
Penalty $ SewerlWater 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 Yous Building Pecmit When Approved Paid ei t No.
Date � •
BuilJin � Ufticial Date
This u to certify that the requcst in the abuve applicauon and accompanying documents is in accordance with thc Ciry Zoning Ordinance and may proceeA as requcsted. This d�xumcnt
when signed by the City Planner constuutes a tempurary Certificate of Zoning compliantt and allows constnution tu commence. Before uccupancy, a Certrfieate ut' Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour notice for aIl inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372