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� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY LITY CONNECTION PERMIT
�r�'NESD�
� m(„006 1. white File
2. P PERMIT NO . d
e City �
3
3. YeQow Applicant
(Please type or print and sign at bottom)
ADDRESS ., C Z G (office use) lv NI
i-\-1,) ?AAA0oor LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER �I Son '1 I G ' 70 (Name) n hone
(Address)
(Company Name) PiY11 Vte -J(`- �c cT 2 -6C�2S IYIII j ` ! (Phone) J " 8 GS - 33
(Contact Name) b (r 130k .svik (Phone)
(Address) W001 'tit) . 0 - 144 i BLvot , LI Cp -ty\- N) g3 0122
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish
- 0 Fireplace
❑Addition ❑Alteration
❑Utility Connection n
CODE: ❑I.R.C. ❑LB.C. isc: \Y 1n Q Y' I/ -� ✓
r
-
Type of Constntction: I II III IV V A B a
Occupancy Group: A COW VALUE H I M R S PROJECT CO ALUE $ ✓ '
Division. 1 2 3 4 5 (excluding land)
I hereb ce I have furnished ' on on this application which is to the best of my knowledge true and correct. I also certify that I . ,. the owner or authorized agent for the
above -. rty ... that . ction will conform to all existing state and local laws and will proceed in accordance with sub • d plans. I a aware that the building
ofii. ^0 ,is . • t for just . '• urthermore, I hereby agree that the city offidal or signee ay enter upon the rty to pert. i . e . • in m d .. s.
Si!, . ture Contractor's License N . Date
Permit 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 $
This Application Becomes Your Building Permit When Approved Paid q - '/5 Recei t N j f 7
Date 777777 9 //� By /'
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 S.E., Prior Lake, Minnesota 55372