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OF PRi�+P CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
,� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
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,�. X AND UTILITY CONNECTION PERMIT
U
��NNEsOt� I. White File PERMIT NO.
2. Pink City 1 4_ r (D b 3
3 Yellow Applicant v
(Please type or print and sign at bottom)
ADDRESS 1 ZONING(office use)
`' i-c t c Q L&k -ei L\ ,
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
-\ 2Q�
OWNS �pAi --02
am' .C��{—] I �V
(Name) Bct \ tk3-ta � t A (Phone) � ` 1 T
(Address) Ac c DA- a
BUILDER /
(Company Name) S L'&C ` I"v Z._"t4.e`2-- / ((Phone) AO. — `Gj
6( -
(Contact Name) (Phone) 95-). •--- -7 /5
(Address)
TYPE OF WORK El New Construction Deck ❑Porch ORe-Roofing ORe-Siding ❑Lower Level Finish El Fireplace
❑Addition ❑Alteratio ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. 0 Misc.
Type of Construction: I II HI IV V A B PROJECT COST/VALUE $
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5 i
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
_I above-mentioned property and that all co.structi.n will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
X! off . w,revoke this permit fort o y+a hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ 41 1 SAC # $
Plan Check Fee $ 51 , D,- Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
A GO
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 $ '79 . 31
This Ailii
lI ica' t Becomes Your Building Perini When pproved Paid ,( Receipt No. IZ�-S3
Date (f I T By W
37.ii'ding Official Dat
This is to certi that e request in the move application and accompanying do iments is accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed b e t ,Planner constitutes a temporary Certificate of Zoning mplianc and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued I I� •
_ 1 �
�y •Director D to Special Conditions,if any
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372
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