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oF PRtp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE r � ' 1, ��
AND UTILITY CONNECTION PERMIT / ��
U �
�►��, i. wn��e File pERMIT NO . T
2. Pink Ciry I�� F� 4
3 Yelbw Applicant �.1 V
Please or rint and si at bottom
ADDRESS ZONING (o�ice use)
I �l �-Op Cc�r�'� � � � �
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address) / L � ! v� � r�'f G�
BUII.,DER {Q [� � � �,��, �� a a 1 a � ! � �
(Company Name) r ��� ��1.'b (Phone)
(Contact Name) ^�t`!1�`�. ,i ��l (Phone) � Sa 2l � �l�t�f'
(Address) `� �,� �c�r /'l �r� �fd = r= G�(� i�� S � 3
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Urility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B pROJECT COST/VALUE $ �^—
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
1 hereby certify that 1 have (iimished information on this application which is ro the best of my knowicdge tnie and correct. I also certify that 1 am the owner or authonzcd agcnt for the
abuve-mennoned property and that all 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 revoke this permit for just cause. Furthermore, I hereby agree that the c�ty official or a designee may enter upon the property ro perform necded mspcctions.
X
Signamre ConuaMOr's License No. Date
Permit Valuation �/ 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 $ �.'7
This Application Becomes Your Building Pernvt When Approved Paid ReCel t NO.
Date l U - 1 B
� �v-�y-,i
Buildin � Ufticial Date
Th�s �s to certify that thc requcst in the abuve applicauon and accompanying documents is in accordance with thc Ciry Zoning Ordinantt and may proceed as rcqu�sted. Th�s document
when signed by the City Planner constirotcs a temporary Certificate uf Zoning compliance and allows construction ro commence. Before occupancy, a Certrticate uf Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9R50, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372