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04 -���� CITI' OF PRIOR LAKE BUILDING PERIVIIT, Date Rec'd
�� �`� J �'' `� �� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
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v J ' AND UTILITY CONNECTION PERIVIIT
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" L Whice File PERMIT NO . ) —��
?. Pink City `
3. Yellow Applicant
(Please e or rint and si at bottom)
ADDRESS ZONIlVG (ot�ice use)
� � r�� �E �� s P�d� � � ,�� ss3�a
LEGAL DESCRLPTION (office use only)
LOT BLOCK ADDITION PID
OWNER �/ _ ��s� ^� G�
(Name) tT��£ / T ���s��U (Phone) ���� � � � J /
(Address) �6 vE,
( UII.,p ER � G�EGGC�GT�tI � E `�`- .�,�E �E �9sa,93-3 - 63� .
Com an Name (Phone
(Contact Name) � U r (Phone)
(Address) 3 �.�g ��"�O�J�`'� � s( . aCJ�S ��CK �y S.S���
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection c '
CODE ❑i.x.c. Di.B.c. �M��: IP�C� J GJr��� .- Of>E��
Type of Construction: I II III N V A B O`�
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $�/��
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished informadon on this applicadon which is to the best of my knowledge true and conect. I also certify that I am the owner or authorized agent for the
above-mendoned pro d that all wnstruction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am awaze that the building
ofT'icial can rev th' 't for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perfoirn needed inspections.
x C,�6�-C����1 �r'o?l-/a2
gnature Contractor's License No. Date
Permit Valuarion Park Support Fee # $
Permit Fee $ SAC # $
Plan CheckFee $ WaterMeter Size 5/8"; 1"; • $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Pee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ .
This Application Becomes Yo� Building Permit When Approved Paid Recei t O
Date B �
i
Buildin Official Date F
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372