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OF PRl;R
CITY OF PRIOR LAKE BUILDING PERMIT, Dal..
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Pink Art
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
v �,
I While I PERMIT NO. _ z 75 I
♦��'lIl 3 y R
3 Yellow Applicant
(Please type or print and sign at bottom) ZONING (office use)
ADDRESS
J'SIS $i H oAl PAS 1\3 - \Al
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER 1•- ROM, ik5 N IS-EM (Phone)
(Name) ll Q � p {, � n MN S
(Address) i5S v� N G 1404k) f lr� I V t.. i' �D P M I J
(Company kOc�S11.& XTE?OkS bjC,. (Phone) ( • 7S9 . Ow
(Company Name)
(Phone) 612 • ` • PI
(Contact Name) �V�� N J � A � C����
(Address) 6/456 /A)G1 000 Rv E, N KD _ uv
TYPE OF WORK 0 New Construction ❑Deck ❑Porch Xe- Roofing DRe- Siding ❑Lower Level Finish 0 Fireplace
DAddiuon ❑Alteration ❑Utility Connection
❑ Misc..
CODE: ❑I.R.C. ❑I.B.C. Q
Type of Construction: I II III IV V A B PROJECT COST /VALUE $
Occupancy Group: A B E F H I MR S U (excluding land)
Division: 1 2 3 4 5
i ho c-men o ed a ropcity and that all information
on t ucton ill conform to all existing state
and local laws and will proceed in accordance with t submitted n i
d plan I am aware that the building
above-mentioned P
1
official can revoke s p• m / ............... u for t cause Furthermore, I hereby agree that the city official or a designee may enter upon the Property to perform needs inspections iS
/ Signature Contractor's License No 6(:)"710`5 Ir Date
Park Support Fee # $
Permit Valuation
Permit Fee $ SAC # $
$
Plan Check Fee $ Water Meter Size 5/8 "; 1 ";
Pressure Reducer $
State Surcharge $
Sewer /Water Connection Fee # $
Penalty $
$ Water Tower Fee # $
Plumbing Permit Fee Builder's Deposit $
Mechanical Permit Fee $ $
Sewer & Water Permit Fee $ Other $ �� �� —
Gas Fireplace Permit Fee I $
TOTAL DUE
< � Reset ,t 7 �� �
This Application Becomes Your Building Permit When Approved I Date 1� . � Re
I
Building Official Date
ermi
srg y
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