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oF rxt CITY OF PRIOR LAKE BUILDING PERMIT, � Date Rec'd
,, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �� �
�' ' � t �; � AND UTILITY CONNECTION PERMIT ' � �
V � � '�� t�1
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��'�NES��P t. Whire F,�e . pERMIT NO.
2. Pink City �� � �/ �i
, � 3 Yellow Applicant � C�/
Please e or rint and si n at bottom)
ADDRESS ZONING (oFfice use)
��.� �v � � U�e. � � r� 1/ G- Pr � v L Cti K-�. !�'1 r'1 S� 3� � Z
LEGAL DESCRIPTION (office use only) `•''
LOT BLOCK ADDITION � PID
OWNER . ,�-.
(Name) � ll 1 v1 I a nn e►� (Phone) q S�- � S U 9 3 U
(Address) S� � 1.t � i� t►� � `n � l' � �c; t ��K-�e !1)'1 �'1 ' �J 37 Z
BUII.,DER �� �i�� ' Ct i - "7a.'d.�'o
(Company Name)��G- � ���� � 1�-rc�e�tic`S�`r (Phone)
(Contact Name) �Y�ti (Phone)
(Address) � ( �4 �Lu.�Si C � 1 � .. � iS c3.rK V(,�.1 ��� ��o
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: �T.R.C. ❑I.B.C. ❑ Misc. ,
Type of Constniction: I II III N V A B pROJECT COST/VALUE $ ��o �JoZ ���
Occupancy Grottp: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5 �
i hereby certify that I have fumished information on this application which is to the best of my knvwledge tnie and correct. I also certify that I am the owner or authorizcd agent for the
abuve-menhoned property and that all conshuction will conform to alt existing state and local laws and wili proceed in accordance with submitted plans. I am aware that the building
otFcial ca revoke this permit for just c se. Furthermore, I hereby agree that the city official or a designee may enter upon the prope3Ty to perform necded mspections.
x��.c•►� � 1���,.�� C i2 f�V � O S C� 8—�7 �� Z—
� 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 Pexmit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & WaCer Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DiJE $
This Application Becomes Your Building Pernut When Approved PSid Recei I�TO.
Date � B
Buildim� Ufticial D�te
This is to certify that tlie request in the above application and accumpanying documenis is in accordance with the City Zoning Ordinance and may proceed 1s requested. This document
when signed by the City Planner constimtes a temporary Certificate of Zoning compliance and allows construction to commence. Before uccupancy, a Certificate of Occupancy must be
issued.
Planning Director Aate Special Condidons, if any
- 24 hour noticc for all inspections (9i2) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372