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PRio�P CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
a TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 5
AND UTILITY CONNECTION PERMIT '
��HHeso't�
I. White File I PERMIT NO.
2. Rink City f�/ V
(Please type or print and sign at bottom) 3 Yellow Applicant /
ADDRESS
ZONING(office use)
5.-:' I 1 ,,,.,.) .,.4 y .....s , ..s . E, F isb
LEGAL DESC I N(office use o )
LOT BLOCK ADDITIO PID ,R5- ( in,, oq .O
OWNER
(Name) r� \�Aiv "...)
(Phone)
(Address) 3 t ) vt C�~Z?,.ti (�4
6 y �l
BUILDER - /
(Company Name) `" 6 1 ^ V y(7
` \ • _ (Phone) a� T lJ � J
(Contact Name) 1� 'p u
(Address) (Phone)
114 •
TYPE OF WORK 0 New Construction ❑Deck ['Porch Ke-Roofing
g ❑Re-Siding ['Lower Level Finish 0 Fireplace
❑Addition ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.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 $ 7(
Division: 1 2 3 4 5 (excluding land)
I hereby cerci',that I have i me, t ation.• 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
II above-me :, property an.lomat all cons action 1 conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
officia .k this permit fu r just cause. irthermo e,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
lc 1 l Z Cr 25-- //v I /J
• Signature
/
Contractor's License No. [ Dat
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
$
This Application Becomes Your Building Permit When Approved �j✓—
Paid �� d f R: : pt No.31 Q
Date /6 9,!S`— I B ,
Building Official Date
IF
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