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��' PRI �'� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" � AND UTILITY CONNECTION PERMIT �� ` �"��• ��
�
�
,. W°"e F�'` pERMIT NO. �
z. e� c�y
3. Yeibw Applicent � � , � �
eaae or ' t and s at bottom
ADDRESS ZONTNG to� �)
_����� G�O��'n ,t.�. }G,� - �F°'
LEGAL DESCRiPTION (office use only)
LOT BLOCK ADDITION PID
OWNER �?' /
(Name) �r�� y V v !i�—� (Phone)
(Address) t� ��-
BUII.DER
(Company Name) �-�" �' — � � � (Phone) �-t� - � � ��
(Contact Name) (Phone) �Z ` �`�' 2 - -� l'l�'�
(a�� " i,�-� � � rn � �- � Cra �-- -
TYPE OF WOR% D rr� conm� pn�t pp� p�-�� -s;a� p�,o� �� F�e p F��
OAeaiaon Cl�ter�noa pvat�ey conneccioa
CODE: []I.�.C. [�I.�.C. p Miec:
Type of Co�on: I II III 1V V A B
Occapanc� Group: A B E F H I M a S U PSOdECT COST/VALUE S
Dirldoa: 1 2 3 4 S (eul�ia� laad)
I hereby catity eFut I ha fumished 'mtoimation on ditt appliption wfiici� u to the beet o[ mr Imowk�e We �nd cotrect. I aho ceitily IAat I ua tAe o�vner or authoiiud a�eot for d�e
above-�t�sd and dut a1 conetnution wl1 canfoim ro all t�tin� rtaa and bai tawa and wnll pracud � a000rdsaoe w�th mbesi�xd plam. I am awue tbat dx �u�disK
oAScial cafl srvoke ' ' far,just canu. Furtf�ermore� I hereby a`ree that drc city oRicial or a Aaisna miy enter npon du propetty to perform needed irupectiorn.
X � �.'3y .S � ;S=Z3 Z� I`c
Si�ature Contractot'a Licrnse No. Dau
Pemut V uation Park Support Fee # S
Permit Fec S SAC # S
Plan Check Fee S Water Meter Size 5!8"; 1"; S
State Surcharge s Pressure Reducer �
Penalty � Sewer/Waur Connection Fee # S
Plumbing Permit Fee $ Water Tower Fee # $
Mechanieal Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $
This Applicarion Becomes Yow Bnilding Permit When Approved Paid Recei t o. � S ���
Date f . i B
Buildin Official Date
T'his is to certify that the xequest in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Plannex constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Diz'ectox Date Specia1 Condilio�s, if any
24 hour nofice for all inspections (952) 447-9$50, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372