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� � CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �
" `� A.ND UTILITY CONNECTION PERMIT � • � � � Z—
r
r �'NES°�
` `""`e F''e pERMIT NO.
2. Pink City
3. Yellow Applicent /� � �
(Please or rint and si at bottom
ADDRESS ZONING (oq'ice use)
iSq23 Tsl�l V►eW (�o��. Ninl
LEGAL DESCRIPTION (oflice use onty)
LOT BLOCK ADDITION PID
�WNER �a�� m {%�S � (Phone) {Q�' �D �2 59 °I � "I'1 �M
(Address) I 5°�23 S st o�.� V � e� 0 � /1 Q1�
BIJII,DER /� . t �
(Company Name) ^ � � �I�OIA,h P�oP e�6�, Pr�es �erva-� � (Phone) 7�0 3'��� ' �j4�1��
(Contact Name) N 1M 41n+ (Phone) �ol Z— �T 3 S 78 Z,�
(Address) '� Z "� WQ�/' � r1V'Q. /"1 ( h Q/� N S S 3y
TYPE OF WORK ❑ New Construcrion ❑Deck ❑Porch �Re-Roofing �Re-Siding �Lower Level Finish ❑ Fireplace
❑Addition ❑Alterarion ❑Utility Connecrion
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc:
Type of Conctruction I II III IV V A B tl . }�
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE S'i t�E�. VU
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information on this applicadon which is to the best of my ]mowledge true and corred. I also certify that I am the owner or suthorized a�nt for the
above-mentioned property and that all construction will wnform to all eJdsting state and local laws and will proceed in accordance with submiued plans. I am aware that the building
official can revoke this r' use. Furthermore, I hereby agree that the aty offiaal or a designee may enter upon the property to perfomt needed inspections.
X 6Gb35��S os ZofZ
Signature Contractor's License No. ate
Permit Valuation Pazk 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 $
Tlus Application Becomes Your Building Permit When Approvcd Paid � Rec t No.
Date ,$�„ _ B
Buildin Official Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance an may proceed as requested. Tlris document
when signed by the City Plaaner consatutes a temporary Certificate of 7.oning mmpliance and allows conswction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions, if siry
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372