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oF PR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
^ � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT � � -- f .Z " ��
�
�I�, � Wh��e File pERMIT NO. a
?. Pink City � 1 � ��j 4
3 Yeilow Applicam Jr� � /
r
Piease or rint and si at bottom)
ADDRESS ZONING (o�t use)
� `� �� 1 '���� .�l ��� � ,'l �
LEGAL DESCRIPTION (oflfice use only)
LOT BLOCK ADDITION PID Z� ,�`k 0. 0 U 3- u
OWNER
(Name) �G' �/ � ,���'7�" � �t %� (Phone)
(Address) r2 � � � ,{ a ,54 �C' � ' i � �c/��' �!�/� .�` 3 7
BIJILDER
(Company Name) l.��CZc°� � �?l�75,r" l �G (Phone) q.�.�-'�' � ���
(Contact Name) ��« ��� �' f t° zrr / (Phone)
(Address) � f ��'' , 3 `,.�t" j � ^� a� L /�C �?>�7 ,S`,�3i',�
TYPE OF W(JRI� ❑ New Construction ❑Deck ❑Porch �e-Roofing ❑Re-Siding ❑Lower Levei Finish ❑ Fireplace
❑Addition ❑Alteration ❑Udlity Connect n
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc. ._� L° /�G
Type of Constiuction: I II III IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE S��� ___—
Division: 1 2 3 4 5
(excluding land)
i hcreby certify that I have fumished information on this ap ' ation which is to the besi uf my knowlcdge hve and correct. I als� certify that I am the owncr or authi�nzcA agent for the
above-mcntioned property and that cunstruction wiil orm ro a(i existing state and local iaws and will proceed in accordance with submitted plans. I am awarr that the buitdmg
I uffi ' revLlke this permit f �ust cau Furtherm hereby agree that the city official or a designee may enrer upon the propetTy ro perform necdcd mspections.
! � r l2 � G � � � q � �. J�`" ,� � --- l�
x ,:�.._.
Signatur Conuactor's License No: Date
Permit Valuation � � Park Support Fee # $
Permit Fee $ – � SAC # $
Pian Check Fee $ Water Meter Size 5/8"; I"; $
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 $ `� 75
Ttus Applic n Becomes Your Building Peemit When Approved Paid Recei t NO.
��6�rtiLC� / U��y � 1� Date U- ,L--� t Y B
l3uildina Ut�icial Date
This u to certify that the request in the above appiicanan and accumpanying documents is in accordance with the Ciry Zoning Chdinance and may yroceed ae requcsted. This dixument
when signed by the City Ptanner constitutes a temporary Certificate of Zonmg compiiance and allows construction tu commence. Before ixcupancy, a C��ruticuc nf Occupancy must be
issucd.
Planning Director Date Special Condidons, if any
24 hour noticc for all inspections (9S2) 447-98St1, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372