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o .� PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� AND UTILITY CONNECTION PERMIT l�' �- l �
c� �
+.�, � Wh,�e File PERMIT NO.� //''
?. Pink City 7 �
3 Yellaw Applicant G./ '
Piease or rint and si at bottom
ADDRESS ZONING (oflice use)
f daZ. y�� �-�'�
LEGAL DESCRIPTION (oflfice use only)
LOT BLOCK ADDITION PID
OWNER /
(Name) �l'?�v�l' (Phone) �I' aZ.�� [%�
(Address)
BUII,DER
(Company Name) �• i �? (Phone) �l 2 � ��f
(Contact Name) �r� (Phone) �
(Address) �'j ��t �j2z. �` �. �Ns� �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e•Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addiuon []Alterarion ❑Udtity Connecn n
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
r,cl� a �✓L
Tyge of Construction: I II III N V A B pR03ECT COST/VALLJE S
Occupancy Group: A B B F H I M R S U
(excluding land)
Division: 1 2 3 4 5
I hereby certiCy that i have fumished information un this application which is tv the best of my knowiedge true and correct. I also cettify that 1 am the owner or authc�r�zed agent for thc
aiwve-menhoned proprrty and that all cunstruction will conform to all exu[ing stare and local laws and will proceed in accordance with submittcd pians. I am aware that thc buiidmg
official can revoke this permit for just cause Furthermore, I hereby agree that the city officia! or a designee may enter upon the property ta perform necded iatipections.
� X -; .t��s--_ ,�c �y-��7� 11- 1 - d �
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 DLJE $
This Appiication Bernmes Yow Buiiding Perntit Whrn Approved Paid Re e' t No.
Date B
F3uildin � Ut�"icial Date
This �s to certify that the requcst in the above applicahon and accumpanying documents is in accordance with the City Zoning Ordinance a may protted as requcs[ed. This dixument
when signed by the City Pianner consamtes a tempurary Certificate of Zoning compiiance and ailuws consauction to commence. Before ixcupancy, a C��rt�ticate nf Occupancy must be
issucd.
Planning Dir�tor Date Special Conditions, if any
24 hour notice for aU inspections (952) 447-984t1, fax (952) d47-424,5
4646 Dakota Street Prior Lake, MN 55372