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� � CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE � Z � ��
" "'' AND UTILITY CONNECTION PERMIT
�
f �'NES��
'. N''"`e F''e pERMIT NO. �
. 2. Pink Ciry ��� �(Z
3. Yellow Applicant (J
(Please e or rint and si at bottom)
ADDRESS ZONING (ofl�'ice use)
�3 �us-� �f�, � C�����e S.�'.
LEGAL DESCRIPTION (oflf'ice use only)
LOT BLOCK ADDITION PID
owivER �► (��c�C.... �S2�2I�7-
(Name) (Phone)
(Address) S � �J�j �OS � pri � p 'rc � e .e - n O�,f' � r�1�J SS3 �2
BUII.,DER Q �/ /�,, � ,,,�,��
(Company Name) �7 �� 1��2GV� �� rg`�►'I�v�T/6� S (Phone) 7 6 3- ��� '"3�l' ��
(Contact Name) � � �-2`Q (/'^ � ` (Phone) L� �2 "'7 3 �` 7 � 2U
(Address) � Z� �Owf.r' � (1 v'e M ��'10� / SS �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �Re-Roofing �Re-Siding ❑Lower Level Finish, ❑ Fireplace
❑Addition ❑Alterarion �Utility Connection
CODE: DI.R.C. ❑I.B.C. ❑ Misc: .
Type of Constivction: I II III IV V A B �
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $�����
Division: 1 Z 3 4 5 (excluding land)
I hereby certify that I have furnished iufomtaflon on this, application wluch is to the best of my knowledge true and coned. I aLso certify that I am the owner or authorized agent for the
above-menfloned rty and that all �nstruction will conform to all existing state and local laws and witl proceed in accordauce with submiaed plans. I am aware that the building
official can r e' permit for just cause. Furthermore, I hereby agee that the city offiaal or a designee may enter upou the property to perform needed inspections.
X �c�3s�Gs a �l`�3 �2o,
Signahue Contractor'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 DiJE , $ . 7
This Applicadon Bernmes Your Building Permit When Approved Paid Recei t I�TO
Date Z B
Buildin Official Date
This is to certify that the request in the above applicadon and acmmpanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner consritutes a temporary Certificate of Zoning compliance and allows construction to commeace. Before occupancy, a Certificate of Occupancy must be
issued.
Planning D'uector Date Special Conditions, if any
24 hour notice for all inspectans (952) 447-9850, faa (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372