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PRI% CITY OF PRIOR LAKE BUILDING PERMIT, Date c' ,� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE SIS .NI AND UTILITY CONNECTION PERMIT
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4,'kNBSOli. I White File
? Pink City PERMIT NO ._ ff4//
/
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
‘ eZS,,,i,eitiooA 5 P.5.1)
LEGAL DESCRIPTION (office use only) / /
LOT t() BLOCK L' ADDITION NB �� /, 4 2 �'� /A- -od,�/ PID j�D ��7
OWNER /e410 Zr
(Name) (Phone)
(Address) -54- wt --
BUILDER
(Company Name) ,iC 6-f ,/ e y /C i S
/�'` N hone) - �r�
(Contact Name) a. 1)/e eAL / (Phone) b -? / c cr
(Address) � e Q bz. - ZTOkd.s i RNA),
TYPE OF WORK D New Construction ❑Deck DPorch 8e- Roofing DRe- Siding DLower Level Finish 0 Fireplace
DAddition DAlteration DUtility Conne tion
CODE: DI.R.C. DI.B.C. 0 Misc. _
Type of Construction: I II III P/ V A B PROJECT COST /VALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5 i
I hereby certi at 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 -ment .n property and t t all will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware t t the building
official c. r oke this rm r )u • ause urthermore, I hereby agree that the city official or a designee may upon the property to perform needed inspections. . �
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`
1 ` Signatu Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ 21 , .75 SAC # $
Plan Check Fee $ .- Water Meter Size 5/8 "; I"; $
State Surcharge $ 5 DO 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 $ 1 7 » 7S
This A a on Becomes : I r Building Permit , en , . proved - %T. F' Recei et No. rai'��► �
• � date 6 1 3 By GA,.,..---
trill g Off •ial Date
This 0 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