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(0 PRio+ CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
A. TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
All,' AND UTILITY CONNECTION PERMIT /0 .2 2f, [5T
iNNEgott' I. Pink" Cit
2. Pink City PERMIT NO. )5 _/3,-)3
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
s_( 5? G40S aAY-0\ `- -. SEI c3rldr (,.akt..t MN 553?a.
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) ,JL 1,. -1;k'bor (Phone)
(Address) $45'1 c„,05s nck-r, sV # set t)rtfar l et.1c,t AIN `5537`)
BUILDER A'_1
(Company Name) I Vl �t).ltyll (Phone) 163 Hit-3TM
(Contact Name) &0,fl avn c.' er1DVII (Phone) `(70- a.11&HO-
(Address) 7 01, t c,C, r p}t.t t,).)i t�. l 1 L ed bin U U.lb.( ivw. 6-$464X)
TYPE OF WORK D New Construction ['Deck ❑Porch GRe-Roofing /Erke-Siding ❑Lower Level Finish ❑Fireplace
1113 ❑Addition DAlteration ❑Utility Connection
E: DLR.C. ❑LB.C. 0 Misc.
e of Construction: I II III 1V V A B �`�
Occupancy Group ABE F HI MRSU PROJECT COST/VALUE $ f�Ty
(excluding land)
Division: 1 2 3 4 5
I hereby certify that 1 have furnished information on this application which is to the best of my knowledge tale 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 o h' permit for Just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X z 1 635465 )0-0)0~1S
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ /(4, / J SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ lob 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
$7...C.‘, 7
This Application Becomes Your Building Permit When Approvediii
Paid � 75 Receipt No. ���_
Date /c 7; c c By i v`
Building Official Date 16 (�
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