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oF PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
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4�ryNFSO�� I. White Pile
2. Pink City PERMIT NO . � Z � (���j
; Yeliow Applicant � F�
Ptease or rint and si n at bottom
ADDRESS � `! f �� � �p� L � �{ � � .�+ r ZONING (otiice usel
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LEGAL DESCRIPTION (ofFice use only)
LOT BLOCK ADDITION PID
� .�.� c n.� B�1t."'ro L �..� (Phone) �P l Z'��' l� 7�S
(Address) � y � Z Z- �L u �'�:.e e� '7x' ,.
BUII,DER
(Company Name) ��rtv �° �£ C �"'� C • (Phone) l0/L' 3 l 0 ry'�O$�
(Contact Name) ��'�� �� (Phone)
(Address) ��� ��`"`� � ��
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Udliry Connection
CODB: R.C. ❑I.B.C. � Misc.
Type of onstiuction: I II III N V A B pROJECT COST/VA,LLTE $ 9�a
Occupancy Group: A B E F H I M R S U
(excluding land)
Division: 1 2 3 4 5
t hereby certify that [ have fumished information �m this application which is to the best uf my knowledge true and mrcect. 1 aiso certify that f am the c�wner or authonzrd agent for the
abuve-ment�oned property and that all construction will conform ro atl exuting state and local laws and will proceed in accordance with submittcd plans. I am aware that the buiidmg
{ utl'iciai can revoke � perm just caus urthermore, I hereby agree that the dty official ar a designee may enter upon the propeity to perform necded mspections.
I x ��������1� �oy ff�loy3 p�r. T..,�. Z�. Z
Signature Contractor's License No. Date
Permit Valuation 0 � , .-. Park Support Fee # $
Permit Fee $ —� � � SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ p p 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 $ "'� q.�(
This ica ' n Bernmes Ya�►r Building Permit A oved Paid ReCei t NO.
Date 3 /y B
\ d Zz� /�
;cial Date
This rs to certify that thr request in the above applicahan and accumpanying documents is in accordance with the City Zoning Ordinance and may proceed i5 requcsted. Th�s d�xvment
when signed by the Ciry Planner consntutes a tempurary Certificate of Zoning compliance and allows constructinn to commence. Befure �xcupancy, a Ceruficue �>f Occupancy must be
icsued.
Planning Directoc Date Special Conditions, if any
24 bour noticc for ali inspections (9S2) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
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