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Oe. CITY OF PRIOR LAKE BUILDING PERMITTEMPORARY CERTIFICATEOFZONING COMPLIANCE Date Recd
et
AND UTILITY CONNECTION PERMIT `� . �� `
4'/J'NEsOlt'
I. White File I T PERMINO. � t�
2. Pink Cityf t3 I 0 J
(Please type or print and sign at bottom) 3 Yellow Applicant `t I
ADDRESS •
ZONING(office use)
/ .710 V— / 7o 4 -7 Kee) ne C .
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION
PID
OWNER �~ �
(Name) a C UTr J•-h v.1 1 Gtr (Phone)
(Address)
/
BUILDER
(Company Name) t^R • 14 o -}-pN
(Phone) 4 ) '), — Cb(r- y14 a 7
(Contact Name) 011 k Q, Co Y LJ , 'e
(Address) - (Phone)
TYPE OF WORK ❑New Construction ['Deck ❑Porch
❑Re-Roofing ❑Re-Siding ['Lower Level Finish ❑Fire t
❑Addition (]Alteration ['Utility Connection pace
0 Misc. \ . . .. L- .
Type of Construction: I II III IV V A B • �� S
CODE: ❑LR.C. ❑LB.C•
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information 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 property and that all construction 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 revoke this permi for just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X/A
Signature / ^ 'Z�- - / c
Contractor's License No. Date
Permit Valuations---0
6r Park Support Fee #
Permit Fee $
$ Z S, r SAC # $
Plan Check Fee $ C �.. .--- Water Meter Size 5/8"; 1";
State Surcharge $ Pressure Reducer
R 93 $
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 41, ."1
Paid , 1 Re ipt No. -2_40
Date 1,0 - V1, [ c B . , 7
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