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M ,� ° � CITY OF PRIOR LAI� BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ,��.,�� r
" `� AND UTILITY CONNECTION PERNIIT ��
�
l� E 5 �`�
`. w`"`e F�6 PERNIIT NO. 3 ��
2. pink City
� 3. Yellow AppGcant
lease e or ' and si at bottom) �"`"
ADDRESS � ,( . ZONING (ott'ice use)
`�33�1 W a o cl�.�. �. 1��' ,�l � C-c� k.sL
LEGAL DESCRIPTION (o�ce use only)
LOT BLOCK ADDITION' PID
(N �c�C�.�,l� 1 Y`'j<N> (Phone) `l J a � aa i '" "IV o�15
(Address) �J � �C� 1 � • C �f.� � dv
(C E Name) !'1I I �CN� S� �XT�Y1 � �'i��� � (Phone) � �d�" `'�it7�`"1 J S�o� �
(Contact Name) �Gl�' � �5 �� �M (Phone) 9' S � - �� _��1 - J`o�'�]_
(Address) A� f i� 1 r Y� J
TYPE OF WORS ❑ New Construction ODeck OPorch e-Roofing �Re-Siding [�Lower Level Finish ❑ Fireplace
�Addition j]Alteration �Utility Conne o
CODE: DI.RC. DI.B.C. ❑ Misc:
Type of Constcuclion: I II III IV V A B J �/q� , ts0
Occupancy Gronp: A B E F H I M R S U PROJECT COST/VALUE $ �/ VI,A_/ `
Division: 1 2 3 4 5 (eacluding land)
I hereby cectify th have 'on on rhis application wluch is to the best of my knowledge uve and correct. I aLso certify that I am the owner or authorized a�nt for the
ove-m aoned an will confarm to all existing state and local laws and will proceed in accordance with submitted plans. I am awaze that the buiiding
o r just u. Furthermore, I hereby agee t6at ihe ciry o�cial or a designee may enter upon the properry to perform needed inspections. �� �
X ��,�3q31 � /� � � �'- �'o
ture Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ a � SAC # $
Plan Check Fee $ Water Meter Size 5/8";1"; $
State Surcharge $ ' Pressure Reducer $
P��tY $ 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 Ap lication Becomes Your Building Permit When Approved Paid fL G fl S +� Recei t No. 7
�� J� �-Ig—II Date B �
Buildin Official Date
This is to cenify that the request in the above application and aocompanying documents is in aaerdance with the City Zon;�o Ordinance and may proceed as requested. This document
when signed by the Ciry Planner oonstimtes a temporary Ceitificare of Zoning compliance and allows oons�on to commence. Before occupancy, a Ceitificate of Oocupancy must be
issued.
Plaaning Director � Date Special CondiBons, if any
24 hour notice for all inspections (952) 447-9850, faz (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372