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fl=�� '�� '� C.I.TY OF PRIOR LAKE BUILDING PERMIT Date Rec'd
�` ��` � TEMPORARY CERTIFICATE OF ZQNING COMPLIANCE
`-' ' � _� �_�� `� � AND UTILITY CONNECTION PERMIT � • 2 • � �
� E S ��
� I. Whiu �Fik ( pERMIT NO . // ...�� /�
2. Pink Ciry
� . . 3. Ydlow Applicant � t
lease e or rinY and si n at bottom _
ADDRESS ZONING (ot�'ice use)
��J�� ��f"��4"" �`� �•�„. ` ft��` L�� �� -:J����
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION ' PID
{Na.�meE (1�1r1 t S � 1 � A �t C'L1 �+�U��OI�'Z. � v'1 t (Phone) Q�r� . � � �� (
�aaar�ss� � r�'� o �L I�� � , r � � � ��3 7�...-
BUILDER /� C�
(CompanyName)� � �t��t" t� (Phone) �a2." ����'7� 1 �1
(Contact Name) ✓1 £.,C (Phone) fea � �. -" ��'S� ' � ,�� �
(Address) �.� S�� w.7 ��t"C I �
TYPE OF W�RI� ❑ New Construction eck ❑Porch ❑Re-Roofing QRe-Siding �Lower Level Finish ❑ Fireplace
�Addition �Altera.bon �UtiliYy Connection
CODE: DI.R.C. ❑I.B.C. �Misc: �� ��'1
Type of Construction: I II III N V A B
Occupancy Group: A B E F H I M R S U PROJECT COSTIVALUE � ��,.��
Division: 1 Z 3 4 5 (eJCdnding Iand) _
I hereby certify that i have fumished information on this application which is to the best of my knowledge true and correct I also certify that I am che owner or auWorized agent for the
above-mentioned piopexty and that all mnstruction will confoim to all existing state and local laws and will pmceed in accordance with submitted plans: I am aware that the build'mg
official can e this pe fa � t cause. R�uthermore, I°hereby agree that the city official or a designee may enter upem ehe property to perform needed inspe rions.
x � � --�5 �,.��°� � //
� Si iure C�nYractor's License No, Date
Pennit Valuation Park Support Fee # $
5��. �,
Pernut Fee $ SAC # $
2J�`.Oc�
Plan Check Fee $ '' Water Meter Size 5/8"; 1' ; $ �
State Surcharge $ . � Pressure Reducer $ ,
Penalty $ SewerlWateL Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Firepiace Permit Fee $ TOTAL DUE $¢�
This Application Becomes Yanr Buiiding Permit When Approved Paid , ,j R 1 t TTO.
Date ,, B
�. Z. � �
Buildin O�cial Date
This is to catify that the request in the above applicaaon and accompanying Aocuments is in aceozdance with the City Zoning Ordinance and may proceed as reques[ed. This document
when signed by the Ciry Plannerconstitutes a temporary Cectificate of Zoning compiiance and alfows canstruction to cammence. Before accupancy, a Ceitificate of Occupancy must be
issued.
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Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952j 447-9850, fax {952) 447-4245
4646 Dakota Street S.E., Prior Lake, Mi�nesota 55372