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o� PRr ��' CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
ti D� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� AND UTILITY CONNECTION PERMIT
�� ��
`�'NES�
�. wn��a File pERMIT NO. _ ILt�.�
2. Pink City ! L-
3. Yellow Applicant
lease e or rint and si at bottom
ADDRESS ZONING (ot�'ice use)
!72(`f C �� SGt� �'or � YY1N 553?2
LEGAL DESCRIPTION (oflfice use only)
LOT BLOCK ADDITION PID
�aWNER dv► �' � l �'' �a �'G ri (Phone) �/2 ' Pi5`} � 3�.�� d /7AN
(Address) l�j,fr � G(� � � �c¢.. ✓�✓� 7 a
B�H�it ONTRACTUI2 � I
(Company Name) �11G1�i� �OriS�YUG'�70N � �rl �- (Phone) _4�2 - y�3 ' g�OU
(Contact Name) ��C U 1 y1 Sal�►(� 8 �- _ (Phone) �/Z 3 63 'O /�D
(Address) qq2� /?
TYPE OF WORK ❑ New Consiruction ❑Deck OPorch ❑Re-Roofing ❑Re-Siding �Lower Level Finish ❑ Fireplace
❑Addidoa �Alteratioa ❑Utility Connection
CODE: �I.R.C. �I.B.C. [�ivlisc: �� indau� r'eD�2Ctrnt.lt�'S t� LU/vtr�olils �
Type of ConstrucGion: I II III N V A B EPIA C L�N �yW
Occupancy Group: A B E F H I M R S U� $�Z�
Division: 1 2 3 4 5 (excluding land)
I hereby catify that I have furnished infarmation on this application which is to the best of my ]mowledge We and coxrect. I also certify that I am the owner ar authorized agent for the
above-mentioned property and that all construction will conform to all existin state and local laws and will proceed in accordance with submitted plans. I am aware that the building
o' can r oke thi mit for just cause. Furthe ore I hereby �ee tha city official or a designee may enter upon the property to perform needed inspections.
� f3CDO ? 25( !o -�-/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 Surcharge $ Pressure Reducer $
Penalty $ Sewer/Water Connecdon Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ ���' $
Gas Fireplace Permit Fee $ TOTAL DiJE $ �
This Application Becomes Your Building Permit When Approved Paid ReCei t O.
Date � B
Buildin Off"icial Date
This is to certify that the request in the above applicadon and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. Z7�is document
whea signed by the City Planner consdtutes a temporary Certificate of Zoning compliance and allows conshvction to commence. Before occupancy, a Ce�tificate of Occupancy must be
issued.
Planning Director Date Special Conditians, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372