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oF PRtp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE /,
� � AND UTILITY CONNECTI4N PERMIT � {.f �t� � � �
�
���'NESO�� i wnae File PERMIT NO .I }�� � 5�
2. Pink fity t
3 Vellow Appflcam
Piease or rint and si at bottom)
ADDRESS ZONING (oEt'ice use�
SDIv/ �a� �--J .
LEGAL DESCRIPTICIN (ofl'ice use only)
LOT BLOCK ADDITION PID
OWNER �
(Name) � � ','e�� (Phone)
(Address) ��-
Coman �N��'�lT'� i �T` � � (Phone) �'! S L- Y �'Z— �.� vJ
� P Y )
(Contact Name) � KS� n! (Phone) �� ��� ! ��
(Addxess) �� 2 ,S - s ,� � e4-� /g�-�_
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
DAddition �Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. 0 Misc.
Type of Construction: I II III N V A B PR03ECT COST/VALUE S
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
i hereby certify th ave fumished information un this application which is ta the best of my know►edge true and correct. I atso certify thaz 1 am the owner or authonzed agent for the
abuve-mennon perty d �il1.cu�sct wiil conform ro all existing state and loca! laws and will proceed in accordance wrth submitted ptans. I am awam that the buildmg
( uFficial can r o this R for t(st cau � gree that the ciry officiai or a designee may enter upon the properry to perform needed �nspect ms.
x �C_fn 39 z�D ��o � �L--
Si Connactor's License No. Date
rmit Valuation ��-�_ Park Support Fee # $
Permit Fee $ � y 7S— SAC # $
Ptan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge � U 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 DI7E �� �
Tluis Appiication Becomes Your Building Permit Whrn Approved Paid �, G Recei t NO. 7 ?
L9 � ' "a'� i� 1 G' � i Date — B
BUII(Ilri�� C)Yt1CtAI Date `
Thrs �s tvi certify that the requcst in the above application and aeeumpanying documents is in accordance with the Ciry Z.�>ning Ordinanee and may proceed as itquc�cted. This document
when signed by the City Plannei conshmtes a temporary Certificate of Zoning comptiance and alluws construction ro commence. Before iKCUpancy, a C��•uticatr nf Occupancy must be
tSStIE`d.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections �952) 447-985t1, fax (952) �17-4245
4646 Dakota Street Prior Iake, MN 55372