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of Pili CITY OF PRIOR LAKE BUILDING UILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT i". 'Z-/�
44'NES011
I. White File I
2. Pink City I PERMIT NO. 4-/
(Please type or print and sign at bottom) 3 Yellow Applicant
ADDRESS
i� c5-a,1
(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION
PID
OWNER �
(Name) T e7Y �� � (Phone)
t
(Address)
i
BUILDER ^/
(Company Name) /a/1/1 ��j ie 5 6..-i /67
�l7 ,,,,/,...R (Phone) Ca/e2—6-GV "O3SQ
Phone
(Contact Name) �,LK - (Phone) ,./ 1/
(Address) 9V7 2 €f— " h r/e A/ �2I
TYPE OF WORK ID New Construction ❑Deck Porch /
['Addition ❑Alteration ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace
['Utility Connection
CODE: ❑I.R.C. ❑I.B.C.
0 Misc.
Type of Construction: I II III IV V A B
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnis ed tau matte on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above-mentioned pro.••-• .,• "at all c on 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 r p • it forju � ermore,I hereby agree that the city official or a designee may ent-r u on th
X / _ / pi}property to perform needed inspections.
Sig Contractor's License No.
ate
Permi 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 A hcati t
PP t comes Your Building Permit When Approved Paid L 1
Rec pt No.
6.,(1,-,ir-
IDate (z_ II B .
Bui !g 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
24 hour notice for all inspections(952)447-9850 Special Conditions,if any
4646 Dakota Street Prior Lake,MN 55372