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o � PR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �'��
� AND UTILITY CONNECTION PERMIT
v �,
'+iNHFSO��' i wn��e File PERMIT NO . /z , /C/��
2 Pink City `
; Vellow AppifcaN /
Please or rint and si at bottom) ,
ADDRESS ZONING (otrice use)
s � 3 � � � �z�-�r w�✓ � �� ��� � �-.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
�DFI�"' ,� �
(Com am /1�� �//�7'� G�ja/;�T�c c.Je s �� ; (Phone) �I ^
� }��JirJ (Phon
dress � j `'' ..— , . � S� �� ��'j J ...
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ' e-Roofing ❑Re-Siding ❑Lower Lxvei Finish ❑ Fireplace
❑Addition ❑Alteration ❑Udlity Conn tion
CODE: ❑I.R.C. ❑I.B.C. � Misc.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $��i �i �
Occupancy Group: A B E F H I M R S U
(excluding land)
Division: 1 2 3 4 5
I hcreby certify that [ have fl�mished information on this application which is ro the best uf my knowlcdge mue and conect. t also certify that I am the owncr or authorizcd agcnt for thc
atx�ve-mcnnoned pr and that all cunstruction will conform to ali existing state and local laws and will proceed in accordance with submitted ptans. I am aware thai the buiiding
ufficial can revoke t is , mu for just cause. Furthermore, I hereby agree that the ciry official or a designee may enter upon the property to pcn form needed msQections.
� X � G ....
►gnature ontractor's License No) ate
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/S"; I"; $
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 DtTE $
This Appiicarion Bernmes Your Building Permit When Approved Paid � Rec ' t No.
Date � /L B
Buildine Ufticial D�te
This is to certify that the requcst in the above appticat�on and accumpanying documents is in accordance with the Ciry Zoning Ordinance and may proceed ati requcsted. This di�cument
when signed by the Ciry Planner conshCUtes a tempurary Certificate of Zoning compliance and allows construction to commence. Before ixcupancy, a C��•uficate nf Occupancy must be
iasucd
Planning DirecWr Date Special Conditions, if any
24 hour noticc for aIl inspections (9S2) 447-9850, fax (952) 447-4245
4646 Dakota StreQt Prior Lake, MN 55372