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oF rR�p� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� ,� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
�' 7 AND UTILITY CONNECTION PERMIT
U X
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�•� I White File pERMIT NO . / � i//
2. Pink City 2 � 7
3 Yellow Applicant
Please e or rint and si at bottom)
ADDRESS ZONING (ottice use)
! � �- �
LEGAL DESCRIPTION (ofllice use only)
LOT BLOCK ADDITION PID
OWNER
(Name) ����i v� �e.��e.r (Phone) PqS2 23 3 — 33�0 �
(Address)
BUII.DER �^�, (� / /
(Company Name) � \ 6� n � � `� �1 P,1� m �2�.P �'K �,1 � O d"�C (Phone) t 7 63 ��' �..� � 1
(Contact Name) � �r'F �: v��S u (Phone) � � � b �
(Address) g( e v� t,.� J
TYPE �F WORK ❑ New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Conn ion
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B pROJECT COST/VALUE $��i 740
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
1 hereby certi' hat [ hav fumished information on this application which is to the best uf my knowlcdge true and correct. I alsu certify that 1 am the owncr or authorized agcnt for the
above-ment prope and that a consttbetion wiU form ro all existing state and local laws and wilt proceed in accurdance with submitted plans. 1 am aware that the buildmg
official ca rev ke this rmit f s ause Furthermo hereby agree that the ciry official or a designee may enrer upon the property ro perform necdcd ms cuuns.
X �,�, ��a,ZQ`� Z
Sign re Contractor's License No. Da e
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 $
This Application Becomes Your Building Petmit When Approved Paid ReCe1 t N .
Date B
BuilJine Utticial Dnte
Th�s �s to certify that the requcst in the abuve applicauon and accumpanying documents is in accordance with the Ciry Zuning Ordinantt and may pn�tted as rcquested. Th�s ducument
when signrd by the Ciry Planner conshtutes a temporary Certificate uf Zoning compliance and allows construction cu commence. Before occupancy, a Certiticate oP Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372