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of pR�oR CITY OF PR , Date Rec'd
TEMPORARY CERTIFICATE
IORLAKE OF ZONINGBUILDINGPERMITCOMPLIANCE Li. /. j
AND UTILITY CONNECTION PERMIT `7
44HNES0:...1 I. White File
2. Pink City PERMIT NO. /4A4 573
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS��� ��� � ` '.-hcoit � �� �� � ZONING(office use)
LEGAL DESCRIPTION(office use only)
Ay:
LOT BLOCK ADDITIONCb/-e?"r , - 41 / / v 4/ PID ,--195 „-/1-) -D3 -C;
(NOame) 1/v k Irk Lb ►' M t VA 'f (Phone) I - to — 51/3 titit
(Address) t D ey,t,,,/, -C�1g1+cc1kiAI v tr'V pv I l�(,(<e q - 0 V
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑New Construction ['Deck Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace
['Addition ['Alteration ['Utility Connectioni d govage,
CODE: R.C. ❑I.B.C. O)(Mise.
CO
Type of C nstruction: I II HI IV V A B PROJECT COST/VALUE $ WOO ✓ •
OccupancyGroup: A B E F H I M R S U
Division: 1 2 3 4 5 (excluding land)
I he b/ •ity that.l h• e hir i -d infor ion 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
abo e-1,� in i, pr6pe• Yt t 1 co s uction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
otTh i. e /p •R' /'r 1 u e thermore,I hereby agree that the city official or a designee may enter upon the property to perform needed i ) . 20
Signature g Contractor's License No. ate
Permit Valuation Park Support Fee # $
Permit Fee $ z_34 ^2c SAC # $
Plan Check Fee $ (5”'3 e 2,1- Water Meter Size 5/8"; 1"; $
&''
State Surcharge $ 3-4)
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 DUEdA 4„ 4 ,-/t, J4.. $ 311
q 14`t1
This Appy n ome You Building Permit Whe Appri ed Paid 345' (� Receipt No. /�/5-zip�'" 6 (O 4 Date ,, /.1.- /Lf By S./44W
V .
Building icial P®
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 ity Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued
/�. / -Snr_rA-ee L Va iy,„9e.
® �'` G 14.7.s 2,te . � ��� ate
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Director Date ��N�r��C w r�
Special Conditions,if any
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372