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of P 4 CITY OF PRIOR LAKE BUILDING PERMIT,
c TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Date Recd
AND UTILITY CONNECTION PERMIT
4fi'1'NESDlP
I. File PERMIT NO.
4 Z i 3 Pink City 1 e
Please ,e or .Tint and si_ at bottom) 3 Yellow Applicant *'° ��
ADDRESS aj'�
i i ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION
PID
4 OWNER ,
(Name) rCTrn ' e, .' ....L.A., `
(Phone) i 3 2Z
(Address) r
j.. BUILDER F
(Company Name)
'^-- `...– �!�� —±A. •40 (Phone) � .-.:2 S P-
(Contact Name) 0 1 1�--k.-
411
(Address) Z� '` O (Phone)
s •
TYPE OF WORK 0 New Construction Deck
�Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace❑Addition ❑Alteration ❑Utty Connection
CODE: DI.R.C. ❑I.B.C.
0 Misc.
Type of Construction: I II III IV V A B
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $
Division: 1 2 3 4 5 (excluddiingg'lannd)
I hereby certify that have furnished information on this application which is to the best of my know�y�true��c �o certify tam the owner or authorized agent for the
above-mentione.. .roperty 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
1 0' can . : e this permit fo use. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed ins ctions.
i
X , G7, r i
Arlimmorpr
afore 21
Contractor's License No. Da e
Permit Valuation _—
Park Support Fee # $
Permit Fee $
SAC # $
Plan Check Fee $
Water Meter Size 5/8"; 1"; 7
State Surcharge $ FiElsgiim
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
I a13 �'.
atioevilYoy: '. , , _ 'ermit WhenPPri edPaidr,�IT
Recei.t No, ���+A. �� Date ;MNB�,,�,ki� R 21 d - .� ri _
Date v `�
This is to certify that above application and accompanying documents is in accordance with the City Zoning Ordinance and may
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,
issued. proceeda as requested. Tansmustb document
a Certificate of Occupancy must be
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