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of PRi j CITY OF PRIOR LAKE BUILDING PERMIT,
�• TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Date Recd
AND UTILITY CONNECTION PERMIT
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I. White File
IPERMITN2Pink City O. �1��t� I
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se type or print and sign at bottom) 3 Yellow Applicant
ADDRESS
'1 _(o 9ZONING(office use)
c)
i-L, 1 is I-3 S C,,,-.. -L ,
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION
PID
OWNER4 ii
(Name) €.�1 ,ik.e..4 Fo..r —
(Phone)
(Address)
BUILDER
ci (Company Name) =_ 4 .ii -rte- _,
i..x . . Em (Phone) to/:2- (v/(, -7137
(Contact Name) 'r\cAA CO Mk- (- R
cA,Y1 Lej4ei (Phone) 9 ..C1- C/y2 _s'/UO
(Address) 3 LI 4 I 6I,.,t.F t 1--) - ra
TYPE OF WORK 0 New Construction ❑Deck
['AlterationPorch ['Re-Roofing ❑Re-Siding ['Lower Level Finish ❑Fireplace
❑Addition DUtility Connection �� t
CODE: ❑I.R.C. B.C. Misc. ' l�A*jt Fe r/\J()/ 1()1/J
e of Construction: I II III IV V A B
pancy Group: A B E F H I M R S U PROJECT COST/VALUE $ tb�'�.
[vision: 1 2 3 4 5 (excluding land)
II 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 permit for just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the propel to perform needed inspections.
t V
r I X Ni Signature
Contractor's License No. Date
Permit Valuation
( 600- ✓ Park Support Fee # $
Permit Fee $
.2-: SAC # $
Plan Check Fee $
-(,I Water Meter Size 5/8"; 1"; $
State Surcharge $ (�
Penalty $ V
Pressure Reducer $
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 t r You ', n t mg Permit n App t ved *c ( CT 1�
I Paid �O Receipt 1
AlizaL �/ Date l� [ByBuilda
Date
Ilsis 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
en 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,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372