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oF rxa CITY OF PRIOR LAKE BUILDING PERMIT, � Date Rec'd
,� ._ � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� :� ? � AND UTILITY CONNECTION PERMIT
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�r�'NES��P '. "'h`" F''e . pERMIT NO.
2. Pink City /� ,� /� � ��
, � 3 Yellow Applicant v
(Please e or rint and si at bottom)
ADDRESS ZONING (oFt'ice use)
I�boW �� �►�� ►� �� 5��"7�
LEGAL DESCRIPTION (office use only) `�•'
LOT BLOCK ADDITION � � PID
OWNER
(Name) ,_(�� � Lv �O� � ie �/ (Phone) R S Z - 23 3- S3 7 S
(Address) l,� �•� U jr— C_� /�{� 5�'J �J 7Z
BUII.,DER p' � a�a -��5 - �,aa�
(Company Name) �-�G- � ne�i�tx� o.� \'�2-m�st�.�,(`�F . (Phone)
(Contact Name) �_���t� ��-'��(r (Phone)
(Address) � � � � �,\Si vr' 1 -� , � �S avk ��� �Co
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: (�R.C. ❑I.B.C. ❑ Misc. „
Type of Construction: I II III IV V A B pROJECT COST/VALUE $� S3� . 6'��
Occupancy Gronp: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have fiirnished info�mation on this application which is to the best of my knowledge true and correct. I also certity that I am the owner or author�zed agent for the
above-menuoned property and that all constniction will conform to all existing sta[e and local laws and will proceed in accordance with submitted plans. I 1m aware that the building
ufficial can r oke this permit for 'ust cause. Fi thermore, I hereby agree that the ciry official or a designee may enter upon the property to perform necded mspections.
X ( e 1<--V(� � b.sd g o"C� � 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 $ �"
This Application Becomes Your Building Pemvt When Approved Paid Reeei t O
Date B �
Buildin�* Ufticial Date
This is to certify that the request in the above apptication and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requestcd. This document
when signed by the Ciry Planner const�tutes a temporary Certificate of Zoning compliance and allows construction to commence. Before uccupancy, a Certificate of Occupancy must be
issaed.
Planning Director Date Special Condidons, if any
• 24 hour notice for ali ins�ections (9i2) 447-9850, fax (9SZ) 447-4245
4646 Dakota Street Prior Lake, MN 55372