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�� PRI �fP CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
ti � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE !
U
� AND UTILITY CONNECTION PERMIT � `�- / �
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i. wn�te F�ia pERMIT NO. �2 �`O�
2. Pink City
3. Yellow Applicent
lease e or rint and si at bottom '
ADDRESS ZONING (ot&ce use)
S3$ �a n o r S� � r'v n'►n/ ?
LEGAL DESCRIPTION (off'ice use only)
LOT BLOCK ADDITION PID
(Na�m E 4� a d� SH a ro,-, � 1 t�(' (Phone) g✓`�z —2. 3?i' �' 0 2�'f
�Aaa�ess� 5 3 S a V�a rr S E ' e rv� nt
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(Company Naxne sarld�t�. t-�5'� �1�.[t�(/Yt. � Zv�c (Phone) �✓'� " y 1�DU
(Conta.ct Name) CV 1 rl Sanda u.. (Phone) 6/Z 3�3 ' O/ ZO
(Address) Q V � � -�✓ _ �
TYPE OF WORK ❑ New Construclion ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding OLower Level Finish ❑ Fireplace
�Addition ❑Alteratioa ❑Utility Conaection
CODE: �I.R.C. ❑I.B.C. 1�'Misc: �111 AGU� �� ornr IreDlA,cemen'� f t5 w i n
Type of Construction: I II III IV V A B � u'► d }
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $��i g 3�� �� " �
Division: 1 2 3 4 5 (excluding land)
I hereby caYify that I have fumished information on this application wluch is to the best my ]mowledge true and comM. I also certify that I am the owner ar autL.irized agent for the
above-mentioned properry and that all construction will conform to all ' tin state local laws and will proceed in accordance with submitted plans. I am aware ffiat the building
offic' revoke this 't for just cause. Furth ore, I hereby a city ial ar a designee may enter upon the property to perForm needed inspeMions.
g i/ � V 0 f�l 9 ' /
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 Di1E �
This Applic Becomes Your Buiiding Permit When Approved Paid . Re t No.
3 Date
in O al Date
T7�is is to c that the request in the above application and acmmpanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This docummt
when signed by the City Planna constitutes a tanporary Certificate of Zoning compliance and allows construction ta wmmence. Before occupancy, a Catificate of Occupancy must be
issued.
Planning Director Date Spacial Condidons, if eny
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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