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�/� ,�� CITY OF PRIOR LAKE BUII.DING PERNIIT, �79 Date Rec'd
�; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
x
"' ' `�' AND UTILITY CONNECTION PERMIT
,�
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l. White File pEg�T NO .
2. Pink City � / / � ��
3. Yeliow Applicant �
(Please e or ' and si at bottom)
�DDRESS ZONIl�TG (ot�ce use)
�
a��o �sr�,d C�r�-e,� r��
LEGAL DESCRIPTION (oflEce use only)
LOT BLOCK ADDITION pID
(Na� � Cti/'U (Phone) _(J` - '7 yd • Clf CP�J
_ /��
(Address) 3 �%(JL l� �r1U2 (.��R, /t� J`�J� V� 7
BUII,DER
(Company Name) (Phone) _�,5� / - 7� �' a� ���
(Contact Name) � (Phone)
(Address) � l ,� 1 � "
��. U �
TYPE OF WORK ❑ New Construction ❑Deck �Porch
, ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish la
❑Addition �Alteration ❑Utility Connection X � ������
.
�ODE: �I.R.C. DI.B.C. ❑ Misc: .
Type of Consstraction: I II III IV V A B
Occu�ancy Cnoup: A B E F H I M R S U PROJECT COST/YALUE ����� e �
Dirision: 1 2 3 4 5 (�� ��
I hereby certify that I have furnished information on this applicadon which is to the besY of my knowledge true and coxreM. I aiso certify thaz I am the owner ar authorized agent for the
above-mentioned property and that all consuuction will conform to all existing staze and local laws and will proceed in accordance with submitted plans. I am awaze Utat t6e building
official can re oke this permit for just cause. Furthermore, I��h}r agxee tkai �ie city official or a designee may enter upon the properry to perform needed inspecaons.
X�� C�m� �o �7� o-a7 i/
Signature Contractor's License No. na*P
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ � � Pressure Reducer $
r
P ��n' $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
1vLechanical Pernut Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ p�� $
Gas Fireplace Permit Fee $ TOTAL DI7E $
This Appiication Becomes Yoiu Building Pcrmit When Approved Paid , ecei t NO.
Date B
Buildin OffScial Date
This is to certify that the request in the above applicadon and accompanying documen� is in accordance with the Ciry Zoning Ordinance and may proceed as requested. This document
when signed by the Ciry Planner mnstitutes a temporazy Certifica[e of Zoning Compli2nce and dllows COnStiuCtion t0 COmmence. Before OCCUpazICy, a Certificate of Occupancy must be
issued.
Planning Direcror Date Special Condi6ons, if any
24 hour notice for all inspectiona (952) 447-9850, faz (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 35372