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°+� � CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec d
D TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" `� AND UTILITY CONNECTION PERMIT �' �. � U�
�
r �'NES��
�. ��te File pERMIT NO.
2. Pink Ciry � � � ��
3. Yellow Applicant L�J
lease e or rint and si at bottom
ADDRESS ',� $.52 ' $� A� j es fi% G ZONING (oR'ice use)
LEGAL DESCRiPTION (ofl['ice use only)
LOT BLOCK ADDTTION PID
°�`'�R i C ,� qs2 - 2 78 - l 700
(Name) e�a, �� ,� /��SmsOa /4,., (Phone)
(Address)
BUII,DER �^
(Company Name) � � � 1 nc � (Phone) ��3 - 20 2- 6 3 y6
(Contact Name) vst�n �+��� (Phone) 7� 3- 20� -�.3Y�
(Address) Lf u r+u� A� �r'r, ., t, c N ,�S3v Z
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition �Alteradon ❑Utility Conne 'on
CODE: �I.R.C. DI.B.C. ❑ Misc:
Type of Constnution: I II III IV V A B 2� 7 9 f
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ /
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information on this applicaaon which is to the best of my knowledge true and coireM. I also certify that I am the owner or authorized agent for the
above-mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am awaze that the building
official can rev e is permit for 'ust cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X � �'_..� � 323s`fi�0 5 - /Z
Signature Contractor's License No. Date
Perxnit V uation 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 Pem�it When Approved Paid Recei NO.
Date °1.� 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 and may proceed as requested. This document
when signed by the City Planner constiwtes a temporary Certificate of Zoning compliance and allows coustruction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning D'vector Date Special Condidons, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372