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o � PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �
.. x AND UTILITY CONNECTION PERMIT �� ��' r �
U �
�'iNNego�� i wn��e File pERMIT NO . � � � ` /. '► �
2. Pink City V �r
3 Yellow Applican�
(Please e or rint and si at bottom)
ADDRESS ZOI�TING (o� use)
� �l � 3 �- l7 �'-e-�' �-e-� c� � r
LEGAL DESCRIPTION (of�'ice use only)
LOT BLOCK ADDITION PID
�aWNER ��C.V� �� !�� C�T (Phone) ��d� �I � (�X� ��
(Address) � � 3 �— ��'�l, � 'r'_
BUII,DER �_ r o � a �� t^ �� O.r.� ) � 2 S l Ll la D Cc 1��
(Company Name) �—`t � (Phone
(Contact Name) -� �� r"`u�' (Phone) (� l gZ D O�
(Address) � C� �e�nc c�l� �Q. Gc.�('W� � /�.�
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch -Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III N V A B PROJECT COST/VALUE $����� �
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
1 hereby certif'y that I have fitmished information on this application which is to the best of my knowledge true and correct 1 also certify that I am the uwncr or authorizcd agent for thc
above-me ioned prope and that a construction will conform ro all existing state and local laws and wilt proceed in accordance with submitted plans. 1 am aware that the buildmg
officia an vok it for st use Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform necded mspectio s.
X
Tv3�{ tp5�t 3� zo � 2-
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 # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $
This Application Becomes Your Building Permit When Approved Paid Re 1 t NO.
Date ,
Buildins Ut7icial Date
Thu rs to certify that the requcst in the abuve applicauon and accompanying documents is in accordance with the Ciry Zoning Ordinance and may proceeA as requcsted. Th1s docurAcnt
when signed by the Ciry Planner constitutes a temporary Certificate of Zon�ng compliance and allows construction to commence. Before uccupancy, a Ccrhficate uf Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fxx (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372