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OF PRio�r. CITY OF PRIOR LAKE BUILDING PERMIT, /
Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
457-576
9-6,-/---c-,
��N"le.' � I. While File PERMIT NO. _
2. Pink City Ijy� / ' / I
(Please type or print and sign at bottom) 3 Yellow Applicant //!'�J /J/
ADDRESS
ZONING(office use)
-3\ (. 6. )i~»`NvC3, < _4-- \-\) . MVS
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER Q� L
(Name) �F�1 Cv�L 1 Cai f 2.<--"ITC.)+e'Ca (Phone) I b2, 232. 7089
(Address) 31 (��j'� ( �1JtLU a (vW
lie 6537Z
BUILDER ,�_ p,
(Company Name) �f j k-1 <>
±, rtt l Cts (Phone) , (2 ( ?E , 1 a)
(Contact Name) ---11-- .,12. -Nr' �SC,�
(Address) �g
e:5-
(Address) (Phone) sol , �g�b
e, 30 �-) 6-4, t T� >�,s B-c-N 55�46G
TYPE OF WORK 0 New Construction ['Deck ❑Porch ORe-Roofing
['Addition ['Alteration g ❑Re-Siding ❑Lower Level Finish ❑Fireplace
['Utility Connection
c�
CODE: DLR.C. DLB.C. �Misc. �t 1� 1�5
Type of Construction: I II III IV V A B .
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ �/ t - —
Division: 1 2 3 4 5
(excluding land)
I hereby certify I have hirnis'•d informati. on this..plication 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-menu. ed property and th all constrt tion will confor• to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can evoke this permit for st cause F 'hermore I h/�. •--city official or a designee may enter upon the property to perform needed inspections.
X --.441tV . frome �
gnature Contractor's License No. Date
Permit V. ation Park Support Fee # $
Permit -e $
Z-G. SAC # $
Plan Check Fee $ rYI'� Water Meter Size 5/8"; 1"; $
I C
State Surcharge $ Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
PIumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee I $ TOTAL DUE $ J !-
This Application Becomes Your Building Permit When Approved Paid /
�_15 Receipt No.
Date � By /nw�—c
9 �
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