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,� CITY OF PRIOR LAKE BUII.,DING PERMIT, Date Rec d
�! � �� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
"�,� .� "�' AND UTILITY CONNECTION PERNIIT
� ��-
r `�'NES�
1. White File pERNIIT NO . {{
2. Pink City ��, V � U) �
3. Yellow Applicaut (J
ease or ' t and si at bottom
ADDRESS ZONING (otsce use)
�3gg
LEGAL DESCRIPTION (oflEice use only)
LOT BLOCK ADDITION PID
(Na�R (Phone) yS�� `t�Y�' �P 0'-l' �
(Address)/ � yh �J 553� a
- c� r,� re. �r ih e.
BUII,DER G ^ ' / c.� �
(Company Name (Phone)� � D �� d� � �-i'
(Contact Name) (Phone) � � 7 � ��
(Address) �� �.r //yr,D /�'� 1'V SSG `
TYPE OF WOR% ❑ New Constrt�ction �Deck �Porch �Re-Roofing �Re-Siding �Lower Level Finish ❑ Firepiace
�Addition ❑Alteration ❑Utility Connection ,
CODE: QI.B.C. ❑I.B.C. �Misc: ��/
T�pe of Constraction: I II III IV V A B ` �
Occupancy Croup: A B E F H I M R S U PROJEC COST/VALUE $ `�
Division: 1 2 3 4 5 (eaclnding land)
I hereby certify that I have fumished information on this applicaflon which is to the best of my lmowledge true and rnnect. I also certify that I am the owner or authorized agent for the
above-mentione erty and that all constructio will conform to all existing statc and local laws and will proceed in accordance with submitted plans. I am awaze that the building
official can r oke thi rmit for just use. F rth ore, I hereby agree that the ary official or a designee ma enter upon the property to perfoim needed inspections.
� � �� � 7 �� �5 � '�- l �
Si e 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 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 $
TT� �►PP��� �m� Y� ��6 p� �� APP�� Paid R i t No.
Date ' �
Buildin O�cial Date
This is to certify that the request in the above applicatioa and ac�companying documents is in ac�rdance with the City Zoning Ordinance and may proceed as requesxd. T7�is document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and altows construction to commence. Before occupancy, a Cutificax of Occupancy must be
issued.
Planning Director Date Special Conditions, if my
24 hoar notice for all inspoctlona (952) 447-9850, fai (952) 447-4245 "
4646 Dalcota 3treet S.E., Pdor Lake, Minne�ota SSi72