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of PR/ CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
7.)
", AND UTILITY CONNECTION PERMIT
4 4NIESOt r I. White File PERMIT NO. i L
2 rink city
3 Yellow Applicant
P1ease4ype- er.pfint and sign at bottom)
ADDRESS II ZONING (office use)
t�7 Oaf �c�5�►�own kd
LEGAL DESCRIPTION o ic u se only)
A N�- 2 00<ic
LOT BLOCK ADDITION PID 45-, q
OWNER k •
ame) - 1 to r 51-06 (Phone)
(Address)
_ l L
1Company Nam � Iu-T rLrn CfiV51' T1 hone) C51 doe 3I3__
.. : . ct Name) JA60,1 PV\ (P . one)
• •dress OW &refit P'k Gave JVi if c9C0 Si, P- l� M+V 55
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Re- Roofing ❑Re- Siding ❑Lower Level Finish
❑ Fireplace
❑Addition ❑Alteration ❑Utility Con ctio
CODE: DLR.C. DI.B.C. ❑ Misc.
Type of Construction: I II III IV V AB PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
1 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 properly and that 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
official can revo its e r - or just cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspect' ns.
X /i /, _
/ Signature a 's I icense No. 1 ,
Perm - 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 $ I G #7.5—
This Application Becomes Your Building P 't When Approved Paid 7 . 73 Recei.. N.1 /
4 g3 �
Date , B A
1 1a /►3 _ .
ding 040 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