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�� �, CITY OF PRIOR LAKE BiTILDING PERMIT, Date Rec'd
� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE v 3 � y �
" � AND UTYLYTY CONNECTI�N PERMIT �
�
j '`'N� S�
�. wmte File pERMIT NO. / /� j��
2, Pink City � �
3. Ydlow Applicent
lease e or ri�rt and si n at bottom
ADDRESS ZONING (ott use)
��'3/ ���'����' ,�.P /G��
LEGAL DESCRTPTTON (office use only)
LOT BLOCK ADDITION PID
�aWNER /� �GL °, '/ (Phone} �o� � 9 /�� � J
%�
(Address) � ���Q��/� /�� � �� c�J"�� ��--�
BIJII.,DER /� /�
(Company Narne) � �J � �'J� {Phone) �/!!7 'J
(Contact Name) (Phone)
(Address) �� /� ���p
TYPE OF WORK {� New Constru�tion �Deck ❑Porch �e-Roofing ❑Re-Siding []I.ower Level Finish 0 FuepSace
❑Addition �Alteration �]Utiliry Connecrion
CODE: �I.R.C. �I.B.C. p Misc:
Type of Construc(ion: I II III IV V A B ,/
Occupancy Group: A B B F H I M H S U PR.OJECF COST/VALUE $� �'"�S �
Division: 1 2 3 4 5 (exciuding land)
I hereby cerCify that I have furnishcd infocxnation on this applicsitiou which is to the best of my knowledge trae and conect. I also certify that I am the owner or suthodzed agent for the
abo�e-men6oaed properiy and that all conswetion will conform to all exisdng statc and local laws and wili proceed in accordance wi[h s�sbmltted plans. I am aware that the bw'lding
oHiaal oke this pemtit for just cause. Fu rmore, T hereBy agree that the eity official or a designee may enter upon tbe property to perform naded inspections.
�[ %////�O / � � d�'�
Signature Contractor's License No. Date
Permit Vaivarion Park Support F� # $
Permit �'ee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8";1"; $
State Surcharge $ Pressure Reducer $
Penalty � Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tawer Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Qther $
Gas Fireplace Perrmit Fee $ TOTAI. DiJE $
This Agplicarion Becomes Your Building Permit Whea Approved Pald � C t Nv.
Date D . . !L
Buildin Of�icial Date
This is to certify that the request in the above applicadon aad accompanying documtnts is in accordance with the City Zoning Ordinance and may proceed as requested This document
whrn signed by tLe City Planner constitutes a temparary Certificate of Zoning wmpliance and allows construction to eammentt. Before occupxncy, a Cestificate of Oecupancy must be
issued.
Planning f)irector Date Speciel Condibons, if mry
24 hour notice tor all inspections (952) 447-9854, fax (952) 447-d245
4646 Dakota Strcet S.E., Prior L.ske, Minnesota 55372 ,
� 79 75