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° �' CITY OF PRIOR LAKE BUILDING PERIVIIT, Date Rec d
� D� TEMPORA.RY CERTIFICATE OF ZONING COMPLIANCE
" `� AND UTILITY CONNECTION PERMIT l'
� �� -�/� 7 p� � y►� � � ` ) � � � I'
��`�N E 5�� �� � /� ��G> ���
1� ��� � l. White File PERMIT NO . ,�,' �� 7
2. Pink City
'?�� � 3. Yeilow AppliqM �
(Please e or rint and si at bottom
ann�ss �c� �n� �r ?'Ra�"L. N� zormvGCo�,�>
P �dn. L� r✓ SS3�a-
LEGAL DESCRII'TION (office use only)
LOT BLOCK ADDITION PID
OWNER �
(Name) � 1� � �� �v � (Phone) b d � ���� I ? � �
(Address) �� 0 3 b � L-Lt,F a'l� 7'12 A�°� E
BUII.,DER � G L �S (Phone) �S'� yy�- �a� y
(Company Name) � h�' R� �11J �s j"1'J�l�'3`A (.�
(Contact Name) ��� � (Phone) G� �- `Z�' t`' d 3 y q
(Address) � � � � �U � �� ��6 �� �� �� �V.d � �l✓ 3 �
TYPE OF WORK ❑ New Consiruction ❑Deck �Porch ,(�Re-Roofing �Re-Siding �Lower I,evel Finish ❑ Fireplace
❑Addition �Altaatinn �Utility Connecao�
CODE: ❑I.R.C. �I.B.C. ❑ Misc:
Type of Constcp�ion I II IQ IV V A B ��
Occapancy ('iroup: A B E F H I M R S U P80JECT COST/VALUE S��
Division: 1 2 3 4 5 (exclnding land)
I hereby certify that I have fumished informaflon on this applicaaon which is to the best of my knowledge true and conect. I also ceitify that I am the owner or authorized a�ent for the
above-mendo d p and that all construction will mnform to all eaosting state and local laws and will proceed in accordance with submitted plans. I am aware thaz the building
of&cial 't f'ust cause. Ftiuthermore, I hereby a�ee that the ciry offiaal or a designee may enter upon the property to petform needed inspections.
X 13�.1 F� � 2� /�J I L 2�l �-
Signature Contreaor'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 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 $
Thia Application Becomes Yau Buildimg Prnnit When Approved Paid C � Recei t N.
Date f � — / _ B
Z�� l�- l S -11--
Buildin Official Date
This is to certify that the request in the above application and accompanying documents is in accordance v✓ith the City Zoning Ordinance and may proceed as requested. This document
when signed by the Ciry Planner constitutes a temporary Certificate of Zoning wmpliance and allows construction to commence. Before occupancy, a Cerdficate of Occupancy must be
issued.
Planning Director Date Special Conditions, if a�+
24 �our eotice for all inspectlons {952) 447-9850, faz (952) 447-4243
4646 Dakota Street SE., Prior Lake, Minnesota 55372