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oF pRt CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE y 2�� /Z
.. � AND UTILITY CONNECTION PERMIT
v �,
'�',� � Wh;�e File PERMIT NO. � �'
2 Pink City �' �
+ Yellow Appiicanl
F�ease or 'nt and si at bottom)
ADDRESS ZONING (o� use)
C� 38� ���d� �. � � b
LEGAL DESCRIPTION (otlf'ice use only)
LOT BLOCK ADDITION PID
OWNER �+
(Name) VJ E �C�.`�l°.f.S (Phone) '�7 �Z y�7 �D��g
(Address) �(c /'�'j C�nC( C /� � r" 'Z
BUII.,DER �(o,� (�1 � ' t(o�o 2
(Company Name) /11/�e, �oc'f' r.n �,�� (Phone)
(Contact Name) ..S.h[zC� �'O�'C�cn (Phone) �o�, � .SS�B Z3C��
(Address) / � $t �.(?° �� �$S 3
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch -Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
�Addition �Alterarion ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Consliuction: I II III N V A B PROJECT COST/VALUE S �. ��g
Occupancy Group: A B E F H I M R S U
Division: 1 2 3 4 5 (excluding land)
t hcreby certify that i have fumished information on this application which is ta the besi of my knowtcdge true and mrrect. ! alsu certify that t am the ��wner or authorized agent for thc
abuve-mennoned property and that ali construction wiil conform to atl existing sta[e and local laws and will proceed in aceordance with submitted plans. I am aware that the buitdmg
ufficial can revoke t ust cause Furthe�'more, I hereby agree that the nty officiai nr a designee may enter upon the property to perform needed ms{xctions.
� x _��5�3�, a88 9-�s- t 2
ignature ContractoT'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 $
Penatty $ 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 DiTE $
This Application Becomes Your Building Perntit When Approved Paid ' ei t NO.
Date 2 0 l/ B
F3uildine Utiicial Date
This �s to certify that the request in the above appiicahan and accumpanying documenis u in accordance with che Ciry Zo�in� prdinance and may proceed ac requcs[ed. Th�s ducument
when signed by the City Pianner consututes a temporary Certificate oP Zoning compliance and allows consuucti�n tu commence. Befure �xcupancy, a Ccruticate iif Occupancy must be
issucd-
Planning Director Date Special Conditions, if any
24 fiour notice for aii inspections (952) 447A13SU, Pax (952) 4A7-A24S
4646 Dakota Street Prior Lake, MN 55372