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o .� PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, �. TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT �- 2 � ��
v �,
''�i � wn��e File pERMIT NO .
? Pink fity � /Z � � / �
3 Yellow Applican�
Please or rint and si n at bottom)
ADDRESS /',� ZONING (o�'ice use)
/Lf 3 g0 (,(,�4-�7�'Q,sEO�E 17ZL �R�, �I�a 2 �'" KE � s37�
LEGAL DESCRIPTION (ot]Ice use only}
LOT BLOCK ADDITION PID
UWNER `
(Name) �N�'r°t'�"'►�'V � �—�' T (Phone) g5�� �LS� = lo.�`rg
(Address)
BUII,DER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re•Roofing e-Siding ❑Lower Level Finish ❑ Fireplace
�Addiaon �Alterarion ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. � Misc.
Type of ConstYUCtion: I II III IV V A B pROJECT COST! VALUE �
Occupancy Group: A B E F H I M R S U
Division: 1 2 3 4 5 (excluding land)
I hereby certify that i have fumished information un this apptication which is to the best of my knowlcdge true and correct. I atso cercify that 1 am the vwner or authonzed agent for thc
above-mcnnoned property and that a truetion will conform to all existing state and local laws and wiil proceed in accordance with submitted pians. 1 am aware that the buildmg
( ufficial c is permit for ju caus F ore, I hereby agree that the city official or a designee may enrer upon the property to perform necded mspcctions.
.
x i 71�.�1 ���
Signature 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 # $
Piumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ �
This Appiication mes Your Building Perntit Whar Approved Paid Rece� t No. (� S 3
Date �_ Z. Z„ B
�7. Z� • IZ-
Buildi s Otficial Date
This u to certify that thr requcst in the above applicanan and accumpanying documents is in accordance with che Ciry Zuning Ordinance and may proc�ed ic mqucs[ed. This document
when signed by the Ciry Planner const�tutes a temporary Certificate uf Zonrog compliancr and allows construction w commence. Befure �xcupancy, a C��vticate �>f Occupancy must bc
issucd.
Planning Derector Date Special Conditions, if any
24 hour notice for ali inspections (9S2) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
oF P�� CITY 4F PRIOR LAKE BUILDING PERMIT, Date Rec'd
� r TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
v �,
'�I�, i, wn��e File pERMIT NO
?. Pink Ciry � 1 Z � ��a
3 Yellow ApplicaN
Please or rint and si at bottom
ADDRESS ZONING (ot�'ice use)
/l/ 3�o k1�4-� 2s E� G£ Tl�[. N. E. ,�(Z� v 2 l.r�- �, MN �537�
LEGAL DESCRII'TION (of�'ice use only)
LOT BLOCK ADDITION PID
OWNER
(Name) ��N;� ���}-23R2r�- �c.r�.v y — (Phone) ���- �oZ.3 ' ls�fq
(Address)
BUII,DER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Aiteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. O Misc.
Type of Construction: I II III IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE S
Division: 1 2 3 4 5
(excluding land)
I hcreby certity that i have fumished information un this appiication which is to the best of my knowlcdge rrue and conect. I also certffy that 1 am the owncr or authonzcd agcnt for thc
abuve-mrnuoned property and that all truch n wiil conform to all exis[ing state and locai laws and wiil proceed in accordance with submittcd pians. i am aware that the buildmg
ufficial can re permit for just use. Fu e e I hereby agree that the city official ar a designee may enrer upon the property m perform needed rns}xctions.
� X `/' /;/ ��.t^^---�
' ature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Ptan Check Fee $ Water Meter Size 5/8"; i"; $
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 Applicarion Becomes Your Building Perntit Whea Approved Paid ReCei t NO ,s
Date G` y B
Buildinz Utiicial Date
Thrs �s to certify that the requcst in the above appIicahon and accumpanying documents is in accordance with [he Ciry Z.�ming Ordinance and may proceed as requcs[ed. T'his document
when signed by the City Planner constitutes a temporary Certi6cate of Zonmg compliance and allows consmiction to commence. Before �xeupancy, a C�vuticate iif Occupancy must be
issucd
Planning Directot Date Special Conditions, if any
24 hour noticc for all inspections (9S2y 447-9850, fax (952) 4�i7-424i
4646 Dakota Street Prior Lake, MN 55372