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Oi Pgio.p CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
e TEMPORARY CERTIFICATE OF ZONING COMPLIANCE / / 6./3
v
IV
IV AND UTILITY CONNECTION PERMIT
4, ptNESo it 2 Pink City I. White File PERMIT NO. �3 , fCj,
3 Yellow Applicant
(Please type or print and sign at bottom)
ZONING (office use)
ADDRESS ----, ) /9 G /11/e ,
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
BUILDER :
- iVAJO V� (Phone)
6 Z , 1(0/ (Company Name)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction ❑Deck ❑Porch ORe- Roofing XRe- Siding DLower Level Finish 0 Fireplace
DAddition DAlteration DUtility Connection �V 1�Q �S /
_ N
CODE: DI.R.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
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 1 am the owner or authorized agent for the
above - mentioned property 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
otliicia an revo. e . rmit fir Just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform neede�pect1oq _ ��
x �__ 1 -- � lG�S' ( '(`
i Signature . Contractor's License No. (' Date
1
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer /Water Conne• ton Fee # $
Plumbing Permit Fee $ Water Tower F- $
Mechanical Permit Fee $ Builder's De : osit
Sewer & Water Permit Fee $ Other $ I Gas Fireplace Permit Fee $ TOT • DUE$ �%
This Application Becomes Your Building Permit When Approved Paid Recei t ■ • .
Date
Building Official 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