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OF PRjd� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT 7
44/NESOlt• I. white File
2. Pink City PERMIT NO. ! : /®�
f
3 Yellow Applicant .1
(Please type or print and sign at bottom)
ADDRESS (� , �, ZONING(office use)
0+-1 k;,J 1b�k id _ \Q- 'ouL Ne. ' 'k/1.0Q-
V-, -•
DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
�^ (/- �q
(NameOWNER) �r Ci l M Q �� (Phone) ( d� 6 ao 581
(Address) , —iCO2J c?„C\Q,Le c Ay_ T N . 091_k. ,
BUILDER S\y� i tC,
(Company Name) M '1 t(� (1-UJI.k Q,K..LS- , (Phone)c016a-.) Ia b — \c'l 47 .
(Contact Name) D',CXJta4 (Phone)
(Address) -f aoO Ey.eQ SSk Ot R:A_J0 _ u*.P ion 40k) -IOS 55 3}{r3
TYPE OF WORK ❑New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ['Lower Level Finish ❑Fireplace
❑Addition ['Alteration ['Utility Conner'on
CODE: ❑I.R.C. ❑I.B.C. ❑Misc.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have furnished information on is applicati.. hich 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 property and that all construct . 1 •- arm to al existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke this it f st ause --are,I hereby agree that the city official or a designee may enter upon the property to perform needed ins ections.
Signatu t
g Contractor's License Na. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; I"; $
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 DUES y R $
`
This Application Becomes Your Building Permit When Approved Paid 9 G C eipt No. f 9`7
Z
Date 6., 2 K. tf y
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
4646 Dakota Street Prior Lake,MN 55372