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of Y R I04, CITY OF PRIOR LAKE BUILDING PERMIT,
Date Rec'c,
` � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
Q : \ ) AND UTILITY CONNECTION PERMIT
'�r O ,SQ '
NN a s I. white City PERMIT NO. y d , /
2. Pink City - ✓ ; y IF 3. Yellow Applicant
. ease 7 or ■ ' , t and si ? , at bottom ZONING (office use)
ADDRESS �
t'-1 S° Doge Coolvt
LEGAL DESCRIPTION (office use only)
PID
LOT BLOCK ADDITION
OWNER (Phone) ° �'3 " 313'
(Name) ` E •
(Address) Yc-i%A.E pcs Po E
BUILDER / 1"A__„,.. 1"A__„,.. (Phone) q S` " S2"Z
tp eta + - Mo ►
(Company Name) (Phone) -, � 3 -- 2-°'-5L3 VI- (Contact Name) W Pd) t ' ‘-S
(Address) °l S k are+' LAS G
,s,_AL__- M) S '19
TYPE OF WORK 0 New Construction ['Deck ❑P ❑
Re- Roofing ❑Re-Sid ng ['Lower Level Finish ❑ Fireplace
❑Addition ['Alteration ❑Utility Connection
Mvsc.
CODE: DI.RC. DI.B.C. e0�
Type of Constriction: I II III IV V A B PROJECT COST/VALUE $
Occnpan Grimy: A B E F H I M R S U (excluding land)
1 2 3 4 5
Division: agent for the
4 application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agm
in accordance with submitted plans- I am aware that the building
I hereby certify that I have an .. t information ' on wi ll conform to 'all existing state and local laws and will proceed to I>� needed . I actions.
above �, tinned property . and t � 13 that the city official or a designee may enter upon the property
Mr_ . or' cy;a3� „ermore, I hereby agree � 'j. � Ol __
�� �— Contractor's License No. ate
S $
Park Support Fee #
Permit Valuation
permit Fee $ SAC # $
$
$ Water Meter Size 5/8"; 1";
Plan Check Fee
State Surcharge
$ Pressure Reducer $
$ Sewer /Water Connection Fee #
$
Penalty Water Tower Fee # $
Plumbing Permit Fee $ $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $ ► -75 Gas Fireplace Permit Fee
$ TOTAL DUE
-75 Recei ►tNo. 0 /
This Application Becomes Your W
Building Permit hen Approved Paid o / B "�'
Date s =_ 3
Buildin_ Official Date
Ordinance and may proceed requested. as reqT� document
documents is in accordance with the City Zoning and n ancy, a e Certificate as seq of ed. This document
tit be
This is i certify that the Planner i the above tem and accompanying c ats Zoning compliance and allows construction to commence. Before when signed by the City Planner constitutes a temporary Certificate of Zoning
issued.
Date Special Conditions if any
Planning Director
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -424
4646 Dakota Street S.E., Prior Lake, Minnesota 55372