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.� � CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec d
D TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" �' AND UTILITY CONNECTION PERMIT �' �� ����
�
r �'NE5��
� �,��e File pERMIT NO.
2. Pink City / � ' �Z�
� 3. Yellow Applicant �
lease e or rint and si at bottom
ADDRESS 3$ S Z�.$� S u�J � ��i G ZONING (oft'ice use)
LEGAL DESCRIPTION (ofi'ice use only)
LOT BLOCK ADDITION PID
owivER � C � q S2 - 2 7F� - l 70
(Name) aa. �� ,+ �.�Sas�a �f1..� (Phone)
(Address)
BUII,DER
(Company Name) � � J ��c � (Phone) ��.3 - 2 D 2 6 3 y6
(ContactName) �st�n r►+�� (Phone) 76,� - ZO?—�.3Y�
(Address) �f �. r,�..� Ci�, ., t��e � ,S`S 362
TYPE OF WORK ❑ New Construcdon ❑Deck ❑Porch Re-Roofing ❑Re-Siding OLower Level Finish ❑ Fireplace
�Addition ❑Alteration ❑Utility Conne 'on
CODE: ❑I.R.C. �I.B.C. ❑ Misc:
Type of Construction: I II III IV V A B 2 Y 7 9 �
Occupancy Group: A B E F H I M R S U PROJECT COST/VALiTE $ /
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information on this application which is to the best of my ]mowledge true and correct. I also certify that I am the owner or authorized agent for the
above-mrntioned property and that all mnstruction 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 a�ee that the city official ar a designee may enter upon the property to perform needed inspections.
X � £'_.� � 323s`�`�0 5 - /Z
Signature Contractor's License No. Date
Permit V uation Park Support Fee # $
Perxnit 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 $
This Application Becomes Your Building Permit When Approved Paid Recei NO.
Date '?� B
Buildin Official Date
This is to certify that the request in the above applicaaon and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner wnstitutes a temporary Cerdficate of Zoning compliance and allows rnnstruction to comruence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning D'vector Date Special Conditions, if any
24 6our notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372