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of PR / CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
x AND UTILITY CONNECTION PERMIT
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4/NNFSol� I. While File PERMIT NO . ///
Pink City / J _ / y
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(Please type or print and sign at bottom)
ADDRESS 1). j 9/ ZONING (office use)
.5431 Cr bSSc.vn ckNac s-1.- 5" 4 c i 6 ( )_604e, ON 5'5"3'72_
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) ti.
(Name) E 4, 5 (Phone)
(Address)
BUILDER
(Company Name) JbQ. H 41 1 ovio Coin s+ ( i L T.NL (Phone) 152 - 94 0 - c3sL
(Contact Name) tA* Mn 1/1-dri (Phone) '?52 — 4'4 0 - S ?s$
(Address) 1-}/OZ 171.+1. S+ E Prof make_ M ,5'S'72_
TYPE OF WORK ❑ New Construction ['Deck ❑Porch ZRe- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ['Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
pe of Construction: I II III IV V A B PROJECT COST /VALUE $
cupancy Group: A B E F HI MR S U (excluding land)
ivision: 1 2 3 4 5
I hereby certify that 1 have furnished information on this application which is to the best of my knowledge true and correct. 1 also certify that 1 am the owner or authorized agent for the
above-mentioned property and thaj all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
officia .n revoke this,' 1 mit for t cause Furthermore, 1 hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X A .- AlturLASII 'G COD a3g0 y f yii3
• . cure Contractor's License No. Date
Park Su
Permit Valuation 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 $ 7y. 7r
This Application Becomes Your Building Permit When Approved Paid ? Receipt 6 / r��
Date / i�3 By / n, �
Building Official Date
s 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
hen 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