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oF PRJp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
.. � AND UTILITY CONNECTION PERMIT � r �� ��
U �
'yj�, i wn��e File pERMIT NO /��
2. Pink Ciry �Z � 7�V
3 Yellow Applicant
rint and si at bottom)
ADDRESS ZONING (otTice use)
� � � �7 G � =.� i ��-- ° � 6: C /f- S '-} � i ..`S �
LEGAL DESCRIPTION (oFlf'ice use only)
LOT BLOCK ADDITION PID
OWNER
ame) l�� �� � S�� �� !'hv d 5 (Phone)
(Address)
B
ompany Name) �n.oa�� � �.� ��' 1�� e.t��t�-� ��c�+�a j� (Phon q S Z 5��� �'�► 3 3
ontact Name �lc J�- �+✓�+-� S one)
ress) �Y� w�+.✓a �� A��'- ��-��c � �K it/ t� ��`��i�
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Conne io
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III N V A B pROJECT COST/VALiTE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have (umished mformation on this application which is w the best uf my knowlcdge true and correct. I also certify that I am the owner or authorizcd 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 pians. I am aware that the buildmg
official can revok this permit for just cause. Furthermore, I hereby agree that the city officia( or a designee may enter upon the property to perform necded mspections.
X _
�,e63�`q ����� �
� ature ontractor's Licens 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 $ -��
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This Application Becomes Your Building Pe�mit When Approved Paid Re ' t No.
Date B
BuilJine Utlicial Date
Th�s �s to certify that the requcst in the above applicanon and accumpanying documents is in accordance with the City Zoning Ordinance and may proceed as requcsted. Th�s ducument
when signed by the Ciry Planner consumtes a temporary Certificate of Zoning compliance and allows consnvction ro commence. Before �KCUpancy, a Ccrtificate uf Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372