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pF PRiO,�, CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
fa I. White File I PERMIT NO. ///yyy
2. Pink City ��.-., /4 ,/
se type or print and sign at bottom) 3 Yellow Applicant
ll �7�AI
lilaDDRESS
‘.‘j\ a, 3 Ivor kt-Nem ,ki,\.t, kl t S�� ZONING(office use)
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LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION
PID,=„).5-.. / • 011. 0
f ((Name) 1\ Y-- \ \-\ �V\(X Tb
J (Phone)
(Address) `\)11.-\a-- Vil- X ti OV t C E
3 BUILDER •
(Company Name) .1.Qr�Q,C,\Y"1'�\") Wan f. WNp Dolle,rfv-- 6. (Phone) b 3 b 1 0 —cla l
(Contact Name) l i 130-1L. (Phone)
(Address) \`VI) Y4 vY`CX Cw v e. 0 tAA 1 'i-., W S
TYPE OF WORK ❑New Construction DDeck ❑Porch ' e-Roofing DAlteration g ❑Re-Siding ❑Lower Level Finish ❑Fireplace
❑Addition ❑Utility Connection
CODE: DI.R.C. ❑LB.C. ❑Misc.
e of Construction: I II III IV V A B
4;ivu,
pancy Group: A B E F H I M R S U PROJECT COST/VALUE $
ision: 1 2 3 4 5 (excluding land)
ai
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 it for just cause. Furthermore,I hereby agree that the city official a designee may enter upon the property to perform needed inspections.
la's/lir
Signature Contractor's License No.
Date
Permit Valuation Park Support Fee #
IS- $
Permit Fee $ "`"ISAC
Plan Check Fee $ Water Meter Size 5/8"; 1";
L9 ' Pressure Reducer
$
State Surcharge $
L $
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- S
This Application Becomes Your Building Permit When Approved Paid --1-C:
Receipt. 6 ip33
Date C i U, (c By t-R,LO
Building Official Date
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
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
cd.
Planning Director Date
Special Conditions,if any
24 hour notice for all inspections(952)447-9850
4646 Dakota Street Prior Lake,MN 55372