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of Pilin CITY OF PRIOR LAKE BUILDING PERMIT, v Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
U
AND UTILITY CONNECTION PERMIT Z
44/4ESO'S� 1 White Fite —�
2 Pint. City PERMIT NO., 1�.
Yellow ApplicantM
__4tint and sign at bottom)
ADDRESS ZONING(office use)
/ 9 ‘G Pe.--)6(.....i , 0--e.,,;_."-- - 6,1.7,4
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
ewly 423.2r V6 3 8Y 6 `7
(Nam�ej �_..2� ,66-,,d4- (Phone)
(Address) / Y 96 6 /�.-e--c-ct /70-e..--..:y C
BUILDER Z� �
ny a /t 4 't- ones" -. :,-2— S art ' 9 S—Z
on ac 'ar e) 7 (Phone) 6 7,2 ` 76, 79 7 y
(Addr s) ',,,.2,/„f' /f -r S'u (/� �'iz~ .S---S---- O
TYPE OF WORK 0 New Construction ❑Deck ❑Porch '�jlRe-Roofing ORe-Siding ❑Lower Level Finish D Fireplace
DAdditton DAlteratton 0 Utility Conn tion
CODE: DI.R.C. DLB.C. 0 Misc
Type of Construction: I II III IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ >"‘"O
/(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 eel ti y that I am the owner or authorized agent for the
above-mentioned property aid 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 revoke this i i it for lust ca use Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections
x liar, - V 260 � /�
-_ attire Contractor's License No Date � 'y
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 / $ '7 - -
This Application Becomes Your Building Permit When Approved Paid ` 17 '`{" R eipt No. ` ` (
Date 7Y-la-------
Budding
'--
Budding Utticial 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 pioceed as requested This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows constiuction to commence Before occupancy,a Ceittticate 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