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��%"�� \` � 9 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec' d
�
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
"` � `� AND UTILITY CONNECTION PERMIT � Z � � ?�
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r `�'N E S��
I. White File pERMIT NO . // _' / lDYI I
2. Pink City
3. Yellow Applicant 4� V
Please e or rint and si at bottom
ADDRESS �-����/ ZONING (oflt'ice use)
t. ��l I I �-� S�� n v�
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER / n c � Q Q
(Name) �CO � h 20 1 /Dc ✓' (Phone) / J � � y7 � "/ (� l l
(Address) � � � l� Iti-� 57��, ��
BITII,DER (�
(Company Name) `� � � �� �v�.�Cv�NS ��" C� (Phone)
(Contact Name) ^ (Phone) � �Z � 15 � 3 _ s� Y / �
(Address) Z 3 � 3 / �`
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �te-Roofing ❑Re-Siding OLower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connechon
CODE: �I.R.C. ❑I.B.C. ❑ Misc:
Type of Constnution: I II III IV V A B �
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE S d d U
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information on this applicaflon which is to the best of my knowledge true and cmred. I aiso certify that I am the owner or authorized agrnt for the
above-mentioned property and that all wnstruction will mnform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can re this permit for just cause. Furthermore, I hereby a�ee that the city official or a designee may enter upon the property to perform needed inspections.
X G ��(rz�o �id C� ,9 -19 -� 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 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 W6en Approved Paid � R i t NO. �i
Date
Buildin Official Date
1'his is to certify that the request in the above application and accompanying documents is in accordance with the Ciry Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning mmpliance and allows construction to mmmence. Before occvpancy, a Certificate of Occupancy must be
issued.
Plam�ing Director pate Special Conditions, if a�ry
24 hour noNce for all inspections (952) 447-9850, faa (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372