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oF PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
F ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE p� ��
.. x AND UTILITY CONNECTION PERMIT �
U �
~��'NES��� �. White File pERMIT NO.
2 Pink City �� �
3 Yelbw Applicam
Please or rint and si at bottom)
ADDRESS ZONING (ot�ice use)
;�� > > � � L � 5���1e � e..
LEGAL DESCRIPTION (oFlf'ice use only)
LOT BLOCK ADDITION PID
OWNER Q
(Name) �O ti C.� � C SO i�- -- --- (Phone) C /�J L-L� � 7 57 V 3
(Address) �n � y (e („� ✓�-�Ce `�/Q,L /t v �
BiJII.DER ` r
(Company Name) �'4 e cl t N ��-'�e�50 N C d N St ,�C, (Phone) �t � Z- ` 7�� - 3y 3� j
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing �Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Uality Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Constiuction: I II III IV V A B pROJECT COST/VALUE $ 02 C� , V ��
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that 1 have fumished information on this application which is to the best uf my knowledge tnie and correct. 1 also certify that I am the owner ur auffionzed agent for thc
abovamentioned property and that all cunstruction will conform ro all existing stare and local laws and will proceed in accordance with submitted plans. I am awam that the buildmg
ufficial can revoke t is r for just cause. Furthermore, I hereby agree that the city oti'icial or a designee may enter upon the property to prrform needed mspecuuns.
X
Signamre Conuactor'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 $� ��
This Application Becomes Your Building Permit When Approved Paid ° R i t NO.
Date
BuiWim� Utlicial Date
This rs to certify that the requcst in the above applicanon and accompanying documents is in accordance with the Ciry Zoning Ordinantt and may proceed as requcsted. Th�s ducument
when signed by the City Planner consntutes a tempurary Certificate of Zon�ng compliance and allows construction w commence. Before uccupancy, a Certificate uf 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