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o � PR�� CITY OF PRIUR LAKE BUILDING PERMIT, Date Rec'd
,, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
- � AND UTILITY CONNECTION PERMIT
v �,
����eso�� � W ""` F ��` PERMIT NO. � ,
2. Pink City � /� _,� �'f L �
3 Yellow Applitant a ��
{Please or rint and si at bottom)
ADDRESS ZONING (otfice use>
SCn.� t���� � . ���
LEGAL DESCRIPTION (ot£ice use onty)
LOT $LOCK ADDITION PID
OWNER +�
(Name) �8�'�'eo-� � � �' "� (Phone) � ` °2 ' ^ < � � `70Z �
(Address) I S � �PL��',1��'.�.,.� � /�-+-�-� � �
BUII.DER '/
(Company Name) � (Phone) ��` oZ " 7 �� � ��'?
(Contact Narne) � � � �� (Phone)
(Address) ��S?'U � � r.�� S' (�G� Ss ���
TYPE OF WORK ❑ New Constcuction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Conn ction
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III N V A B / �d� ��
Otcupancy Group: A B E F H I M R S U pROJECT COST/VALLTE S 1.�� "
Division: 1 Z 3 4 S
(excluding land)
1 hereby ccrtify that [ have fiimished information on this application which is ro che best of my knowledge nve and conect. I also ttrtify that I am the owner or authonud agent for the
above-mentioneQ properry and that ail construction will conform to a(1 existing state and local ]aws and will proceed in aceordance with submitted plans. I am awarr that the buildmg
ufficial can revuke this permit for just cause- Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform necded iacpections.
X
5ignature Conuactor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Pian Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer/Water Cannection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOT.AL DUE $ . 1
This Appiication Becomes Your Buiiding Pe�mit When Approved Paid Recei t o
Date B
Buildin � UtTiciul Date
Th�s �s to certiEy that thc requcst in the above applicauon and accumpanying ducuments is in accordance with the City Zoninb Ordinancc and mty proceed as rcqucsted. Th�s d�xument
when signed by the City Planner cunsututes a temporary Certlficate of Zoning compiiance and aUuws conshuction tu commence. Before �iccupancy, a C�K'nticate of Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspecteons �952) 447-9R5(1, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372