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oF PR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
v �,
��ryNESO�� I. Whi�e File PERMIT NO. � ``��'�
2. Pink Ciry L -�
3 Yellow Applitant
Please or rint and si at bottom
ADDRESS ZONING (ottice use>
�'!�� �7 `� �c,�r,m,�w l� ��✓`aC- �r�z� C, 11/' �_
LEGAL DESCRIPTION (off'ice use only)
LOT BLOCK ADDITION PID
OWNER `T rn �� � 1 � �C�� �� � (Phone)
� �/
(Address) ���� � Y11t`I'� �J� �1/�.- T�ar � d� �
BUILDER CL CuLS'�'d�^'t ��� �0'�.ctS � �L°�'l�iP�'��' ''�
(Company Name) (Phone)
(Contact Name) �'�L� YdU-�'1 t-° S (Phone) � � � ' a � �- S ��
(Address) /,�t� / �,,°�� °z.Y Lk �/Q,oC -
TYPE OF WORK ❑ New Consrruction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Conshuction: I II III IV V A B ` °�
PROJECT COSTNAI.UE $ /,� v�
Occupancy Gronp: A B E F H I M R S U (exclixding land)
Division: 1 Z 3 4 5
I hereby certiEy that [ have fumished information an this apptication which is tu the best of my knowtedge ave and cnrrecc I aSsu certify thac 1 am the awner or authorszed agent for tlx
above-menUOned property and that all cunstruetioq will conform to att existing state and tocal taws and will proceed in accordancr with submlttcd p(ans. I am aware that the buildtng
ufFicial can r voke this permit for �use ca se Furthermore, I hereby agree that the c�ry official or a designee may enrer upon the property to perf'orm necded mspe:ctions.
X �c-6�17�33 s?p-1�',�oi�
Sign re Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Flan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer �
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 $ �_ 7
This Applicadon Becomes Yoar Building Permit When Approved Paid ReCei t �
Date B
Buildin � C3tlicial Date
Thu u to certify that thc requcst in the abuvr applicanon and accompanying documen[s is in accordance with the Ciry Zoning Ordinance and may proceed as requcsted. This dixument
when signrd by the City Planner constrtutes a rempuiary Certifieare uf Zoning compliance and alluws canstruction tu commence. Befi�re uccupancy a Ccrtificate of Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour notice for aii inspections (9 +2) 447-4RS0, fax (952) 447-4245
4b46 Dakota Street Prior Lake, MN 55372