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o � pR��� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
.�, � AND UTILITY CONNECTION PERMIT
� �
��N o�'' � W�,�e File pERMIT NO. � L—// y�
NES 2 Pink City
3 Yellow Applicant
Please or rint and si at bottom)
ADDRESS ZOI�TING cor���� �S�>
� 5 � a � 3�. r 5 P�.SS (ul.�
LEGAL DESCRIPTION (office use onty)
LOT BLOCK ADDITION PID
�aWNER J�P�� (Phone) -6J�p�'�(o� ✓�`� /
J, (Address)
BIJII.,DER (Phone) �s��'J� y T��
(Company Name) '(�-� �`h� A'�S�S.��
(Contact Name) (Phone)
(Address) �9 0� CA • 1�t• � � � W �S�" ' �OS � ��2, � � �
TYPE OF WORK ❑ New Construccion ❑Deck ❑Porch ❑Re•Roofing ❑Re-Siding ❑Lo er Level Finish Fireplace
❑A�ddition ❑Alteration ❑Uriliry Connection � `„ � �� (�/� � W S ��'� `—e� � S� �
'� 1.(/�
❑ Misc. �'��� � '
CODE: ❑I.R.C. ❑I.B.C..,. C�
Type of Constiuction: I' II III IV V A B pROJECT COST/VALLTE $��� [���
Occupancy Group: A B E F H I M R S U (excluding land)
Division: ` 1 2 3 4 5
1 hcreby crrtity that t have fi�mished mformation on this application which is to the best uf my knowlcdge tn�e and currect. I alsu certify that 1 am the owncr or authonzcd agent for thc
abuve-me ioned prope�ty a t atl construction wiU conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
official c revok [hu prrm for st cause Furthermore, I hereby agree that [he ttty official or a dcsignee may enter upon the property to perform necd�� specho� ��
'�G13 a9g3 J
X Contraccor's License No. Date
Signature
Permit Valuation Park Support Fee # �
Permit Fee $ SAC # $
Plan Check Fee $ Water Ivleter 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 Fireplaee Permit Fee $ TOTAL DUE $
This Application Becomes Your Building Permit When Approved Paid ReCei N 3
Date D � B '
Buildins Ut7icial Date
Th�s �s to crrtify that thc requcst in thr abuvr applicanon and accumpanying documents is in accordance with thc Ciry Zoning Ordinancc and may procred as requ��ted. Th�s d�xument
when signed by the Ciry Planner const�mtes a tempurary Certificate uf Zoning compliance and allows construction tu commence. Befurr �xcupancy, a C�vnficate iif Occupancy must bc
issucd.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (9S2) �t47-98511, fax (9S2) 447-4245
4646 Dakota Sueet Prior Lake, MN 55372