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o f PR/ CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
r TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AN
x
AND UTILITY CONNECTION PERMIT
rr
MiA 'NEsCI I. White File '
2. Pink City PERMIT NO _
3 Yellow Applicant 2:2_,A__ 1
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
I 02X,) Spf Lake_ ti oAcl Su.)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER "�
(Name) Flo h rt A nd I e_n k s f✓ rats (Phone) 5 - y (7 S
(Address) a as Sp f` t r1 LA ke. 4icies S Pr o
' r"' LA in N �3 3 7
BUILDER J
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Const uct ['Deck ['Porch DRe-Roofing Re- Siding DLower Level Finish ❑ Fireplace
['Addition Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. Misc. w ln+Ocod.A 'S 4 PPee-c.,
I II III IV V A B v �o "2"' Type of Construction: PROJECT COST /VALUE $ -�
Occupancy Group: A B E F HI M R S U
Division: 1 2 3 4 5 (excluding land)
I
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above - mentioned property and that all constr ill conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
officia can revoke this permit for just cause Furt more, I hereb ree that the city official or a designee may enter upon the property to erform p needed ins p e ctions.
X 0 .-.1 C rtgA.-9
Signature Contractor's License No. Date
Permit Valuation o O0 � - Park Support Fee # $
Permit Fee $ (081 SC) SAC # $
Plan Check Fee $ 4&5. 83 Water Meter Size 5/8 "; 1 "; $
State Surcharge $ 2 S. — 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 $ MC- '> 3
This A 'cat' i Be . our Building Permit e Approved Paid Recei.t No. Cv Z S
A 4- Date B � I
i
B iilding O Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372
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