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oF PR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
U trj
~�4'NESO�h I. White File PERMIT NO . �
2. Pink fity /y _ 1��
+ Yeilow Applicanl
Piease or rint and si at bottorn
ADDRESS ZONING (ot��ce use)
5 ��V �.�'f 'G�'1 �l''� ��c��� �� S���Z
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER r /�� /' Q
(Name) �i _.�y. .-� � (�l C� �i � (Phone) / �-- �Y7 — � � �
(Address) l�� 7 0 �- c ti - f/` n�. �� �S 3 Z.�
BUII,DER �/�/ '/� / 1 �
(CompanyName) ✓ l ""''1 v�c�� C°�sT (Phone)
(Contact Name) TJ •� �.�/� (Phone) � � Z— ' Z ° ( ^' � 1 S �
(Address) �•�, ��,� �'� `'f {�r �. �� �n , $ � �' Z
TYPE �F WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Levei Finish ❑ Fireplace
❑Addition �Alreration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. � Misc.
Type of Construction: I II III N V A B pROJECT COST/VALUE S � T��
Occupancy Group: A B E F H I M R S U
Division: 1 2 3 4 5 � l�� (e ludin��`
I hereby certiCy that i have fumished mformation on this application which is W the best of my knowiedge true and correct. [ alsu certify that I am the uwner or authonzed agent for thc
abovr-menhoned property and that a11 construction will conform to all existing state and local laws and will proceed in accordance with submiucd plans. I am aware that the buiidmg
ufficial can re ke this permit f just cause urthermore, I hereby agree that the city official or a designee may enter upon the propecty ro perform necdcd mspettions.
X � �� �G-� �-�4-/z
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 DUE $ '79. 7
This Application Becomes Your Buitding Pemtit Whrn Approved Paid Recei N
Date y B
BuiWine Ufticial Date
This is to certify that the request in the above application and accumpanyin� documents is in accordance with the Ciry Zi>ning Ordinance and may proceed ac requcxted. This d�kument
when signed by the City Planner cnnsdtutes a temporary Certificate of Zoning compliance and alluws construction tu commence. Before �xcupancy, a C�ruficate af Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for aIl iospections (952) 447-9850, fax (952) 447-4245
4646 Dakota Sueet Prior Lake, MN 55372