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o � PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� x AND UTILITY CONNECTION PERMIT
U �j � � � --� �
~��'NES��� I. White File PERMIT NO . ^1 l
2. Pink City � '� � V.
S Yeliow Applitant �
Plcase or rint and si at bottom
ADDRESS ~ ZOI�TING (ot�'ice usel
,� r � �D-�-a ��� c�- � �.
LEGAL DESCItIPTION (oflf'ice use only)
LOT BLOCK ADDITION PID
�WNER fl_,__�tX� � �,�W�M�• �'l�A�✓ 6� (Phone) �'.5�� 2�0-1 � �S �
T���
(Address) ���_
BUII,DER � �� ^ _ ``
(Company Name) l�b (Phone)
(Contact Name) (Phone)
(Address) 'j� �1�.
TYP'E �F W�RK ❑ New Construction ❑Deck ❑Porch e-Roo6ng ❑Re-Siding ❑Lower Level Finish ❑ Firepiace
❑Addition ❑Alteradon ❑Urility Conn �xion
i
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III N V A B
Occupancy Groap: A B E F H I M R S U PROTECT COST/VALUE S
Division: 1 2 3 4 5
(excluding land)
I h�Keby c' that [ have fumisl�l informatian un this apptication which is to the best of my kn�wicdge true and correct. I aiso crrtify thac I am the owner or authonzed ag�mt for the
above-men pr and thac all cunsauction will conform to aU exuting state and tocal laws and will proceed in aceurdance with submitted plans. I am awam tNat the buiidmg
ufficiai c re k is permi ust cause Furthermore, I hereby agree thai the ciry officiai or a designee may enter upon the property to perform necded mspections.
X
Signature Conuactor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ �L � SAC # $
Pian Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ d Pressure Reducer $
Penaity $ Sewer/Water 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 $ '7� ��
Thia Application Becomes Your Buildittg Permit When Approved Paid ReCei t NO.
L��� Date — o—� Y B
,,�„�/ � " �CJ � �'
Buiidin � Ut�icial Date
This �s to certify that the requcst in the above appticauon and aceompanying documents is in accordance with the Ciry Znning Ordinanee and may pr�ceeA as requ�sted. 'fhis dixument
whrn signed by the City Planner cunst�tutes a tempurary Certificate uf Zoning campliantt and aUuws canstnucion tu commence. Before �xcupancy, a Cctitdicate uf Oceupancy must bc
issucd.
Planning Director Date Special Conditions, if any
24 hour notice for �ii inspecfians (952) d47-98SQ, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372