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o F PRtp CITY OF PRIOR LAKE BUILDING PERMIT, � Date Rec'd
;� TEMPOR.A.RY CERTIFICATE OF ZONING COMPLIANCE
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,�� � AND UTILITY CONNECTION PERMIT
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���'NESD�P 2. 1'in �;� PERMITNO. ._ys�
, 3 Yellow Applicant �
(Please e or rint and si at bottom)
ADDRESS ZONING (oFtice use)
5 3- �-s lV E 1�v �' St
LEGAL DESCRIPTION (ofFice use only) "��'
LOT BLOCK ADDITION � � PID
OWNER �. �^ `�
(Name) 1 �Ct n t � J U Y�1 � .S (Phone) Q c JZ ^ 7 �S — �3 �o �
(Address) '" -rj 11 �j (;;` � � )-- C, vl �'J �—✓ 3 7 Z
BUII.,DER p 4 �� q 5� '� i�J - `Z ai}.Co
(Company Name)��-�G- �ot�t�c�c a-nd \{e-rrx�c�tl,�t`�rr (Phone)
(Contact Name) �e��� ��t.�icx (Phone)
(Address) � ( (� �,�i(�,\5i �r' 1 � e � �S avu V(,b.l ��Jy ��[i
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: DI.R.C. ❑I.B.C. ❑ Misc.
Yp `CR� � / �
T e of Construction: I II III N V A B pROJECT COST/VALUE $
Occupancy Gronp: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify tl�at I have fiimished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorizcd agent for the
above•mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
ufficial can r voke this permit forjust cause. uithermore, I hereby agree that the city official or a designee may enter upon the property to perform necded mspections.
X ��a� � Ci2- 6o t o So S^ 20 �I 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 Sureharge $ 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 DiJE $ �"
This Application Becomes Your Building Pernut When Approved Paid Ci f/�G � Recei t o.
Date B
�'/t,. '�- (�-
Buildin�� Ufticial Date
Thu is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed 1s requcsted. This document
when signed by the Ciry Planner consntutcs a temporary Certificate of Zoning compliance and allows construction to commence. BePure uccupancy, a Ccrtificate of Occupancy must be
issiied.
Planning Director Date Special Condidons, if any
� 24 hour noticc for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372