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o � PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
y ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE j� 1�� I �
X AND UTILITY CONNECTION PERMIT � �`_
U �
~�A'NES��� 1. Whi�e File pERMIT NO . ^
2. Pink City � � � L
3 Yeliow Applicant 7
Please or rint and si at bottom
ADDRESS ZONING (ott'ice use)
..a .rr a�/ C..� +` � < }^ .
LEGAL DESCRIPTION (office use only)
- LOT BLOCK ADDITION PID
OWNER
(Name) 1�'•� �� C C) (Phone) �r �o� ' f� S` S' ` / S o
(Address) �4�"
BUII.,DER ,� � f �
(Company Name) �� �i��� =. l� .�—�` � (Phone) G�ol ' �l � 7' � 7��
(Contact Name) �tin �,�/'�:.►��-- (Phone) � �
(Address) ti l/G' l.,/ 1�• ► tr�� G ih YIJ
TYPE OF WORK ❑ New Consauction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑UUlity Conne ion
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B PROJECT COST/VALLTE $�S �'� ��
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certif'y that I have fiimished mformation on this application which is to the best uf my knowledge tnie and correct. 1 also certify that I am the owner ur authonzed agent for the
above-mennonrd proprrty and tpaqall construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
official can sevo this permu fio�ust cause Furthermore, I hereby agree that the ciry official or a designee may enrer upon the properry to perform necded mspecnons.
X T��� a�s ,�-� �,� � ��
�'Signature Contractor's License No. Date
Permit Valuation U . G 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 $ 7
This Application Becomes Your Building Perntit When Apptoved Paid � I�t Recei t NO.
Date G�1-1-� B
I G -� �
BuilJim� Utlicial Date
Th�s �s to certify that the requcst in the abuve applicauon and accompanying documents is in accordance with the Ciry Zoning Ordinancv: and may proceed as requested. Th�s dixument
when signed by the Ciry Planner consurotes a tempurary Cei7ificate uf Zoning compliance and alluws consh to commence. Before occupancy, a Ccitificuc nf Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372