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o � rR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
U �r
♦j �. „-n,�e File pERMIT NO
2. Pink City �� � ��/�
� 3 Yellow Applicant T
Please or rint and si at bottom
ADDRESS ZONING (ot�ice use)
1 S�l 7 O (,�.?4e "
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDTTION PID
OWNER �/ r
(Name) Tb d1,� //G11 U � G'? (Phone)
(Address) � s�� 7 � B d`-'�' �C/ f/�'i i�
BUII.DER �� � ��Z � �� ^S �C�O�
(Company Name) 1'}:Y1 �P "FCf�.'f t ��'l � G v,rQ (Phone)
(Contact Name) t" • (Phone) 76,� —374 - 4d �
(Address) Cfl pi �/ , t
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Udlity Connecnalr 2 �
CODE: �.R.C. ❑I.B.C. ❑ Misc. J'S � �
Type of Cons�uction: I II III N V A B PROJECT COST/VALiTE $ D Q
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby cenify that I have fumished mformati¢n un this application which is ro the best uf my knowlcdge true and correct. I also certify that I am the owncr ur author�zcd agent for the
above-mennoned p perty and that all construction wip conform to alt existing state and local laws and will proceed in accordance with submincd plans. I am aware that thc buildmg
ufficial can revo is permit for jus us Furth rm , I hereby ag�e that the city official or a designee may enter upon the property to perform necded mspe tions.
X � /:�C' 63 7Z 3 �
Signature —� Contractor's License No. Da
Permit Valuation � �� f _ 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 $ �
T Appl ec mes Your Building Permit A roved Paid ReCei t No.
� Date B
2—
IJin � Utlicia Dat
Th�s �s to certify that the requcst in the abuve applicahon and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requcsted. This document
when signed by the Ciry Pianner consntutes a temparary Certificaze of Zoning compliance and alluws construction tu commence. Before occupancy, a Cemficam uf Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372