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��'; PR I �� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
�-` %� '' �� �'� 9 TEMPORARY C�RTIFICATE OF ZONING COMPLIANCE
"'� r 'L_\��1 `Z' AND UTILITY CONNECTION PERMIT
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� �u File PERMIT NO. �
2. Pink City � %� ��
3. Yellow Applicant V
lease or ' t and si at bottom
ADDRESS ZONING (otr�ce use)
� 1 S � ��,�s C; �
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNE �q I
(Name) �C'�c? i rv � U ��� r?� O.r , ,^ , , (Phone) �I S � � 1 U
(Address) J��s � �j��� S Ci l' f`l�/ C�Jce �'1 Iv � 3��
BUII.,DER
(Company Name) SelecfEt�/' N �/�"Rv�io�J (Phone)LoSI •�o 3 / .34
(Contact Name� (Phone) �� i S9 Z�d 7`�
(Address) 1 Z� Gert'�I'e �o't �' % t/ �� �"' � J � fYll•'� SS � Z�
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Q�-Roofing �Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition �Alteration ❑Utility Connection
� CODE: ❑I.B.C. �I.B.C. ❑ Misc:
Type of Construction I II III IV V A B
Occupancy Group: A B E F H I M B S U PROJECT COST/VALUE $ 3.�
Division: 1 2 3 4 5 (excluding land)
I hereby cerflfy that I have furnished information on this apptication wluch is to the best of my knowledge ave and conect. I a]so cerG�fy that I am the rnwer or authorized ageat for the
above-mendoned property and that all �nstruction will conform to all existing siate and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke this permit for just cause. Furthem�ore, I hereby agree that the city offiaal or a designee may enter upon the property to perfoan needed inspections.
x`� /� .�?o S�{'"`7`0� L�C� 7� Cs � � �
Signature Contractor'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 $ 'I „� j''
This Application Becomes Yoiu Building Permit Whtn Approved Paid Recei t O.
Date / 11 B
Buildin O�cial Date
This is to cerdfy that the request in the above applicafion and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. Tlus document
when signed by the City Planner constitutes a temporary Certificare of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Diractor Date Spacial Conditions, ifany
24 6onr notice for alI inspections (952) 447-9850, faa (952) 447-4245
4646 Dakota Strcet S.E., Prior Lake, Minnesota 55372