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oF PR�O� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �
� � AND UTILITY CONNECTION PERMIT `� � � ��'
U �
♦�HNBSOS� i. Whi�e File pERMIT NO
2. Pink City � � �� ` � �
3 Yellow Applitam
Please or riut and si at bottom
ADDRESS ,p n �✓�(. � / � j ,� , ZONING (of�'ice use>
��� / / i1 el/e �w �C/�' � �
LEGAL DESCRII'TION (ot3Fice use only)
LOT BLOCK ADDITION PID
OWNER /,
(Name) // �� (Phone)
(Address) � �/� j /�ihevi ��- ,�
BUII,DER � /'� � C. �/.�' / �0- /
(Company Name) (Phone)
(Contaet Name) Qli ' ✓�- (Phone) ��a- 9�n l
(Address) � v 2 . /v Lv- rt �sQ / /�'il . -�5..�'O
TYPE OF WORK � New Construction ❑Deck ❑Porch ❑Re•Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition �Alterauon ❑Uality Connection <
CODE: ❑I.R.C. �I.B.C. � Misc. )� �
Type of Construction: I II III IV V A B pROJECT COST/VALIJE S
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
1 hereby certify that I have fumished information on this application which is ro thr besc of my knowicdge mue and correc[. 1 alsa certify that I am thr owner or author�zed agrnt for the
aiwvr-menuoned property and that ap cunstruction will conform ro atl exis[ing state and iocal laws and wii! proceed in accordance with submittcd plans. I am aware that the buildmg
ufficial can � r p ke �is prr 't for just cause- Furthermore, I hereby agree that the ciry official or a designee may enter upon the property to perform necded mspections.
x �/.�.� . _ ,�C'�3o��.Z /o /Z--
�— Signature Conaactor's License No. te
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; I"; $
State Surcharge $ Pressure Reducer $
Penaity $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # S
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $
This Applicadon Becomes Your Building Perrnit When Approved Paid ' ecel t NO.
Date U B
Buildin � Utiicial Dnte
T'hu �s to certify that thc requcst in thr abuve appiicahon and accompanying documents is in accordance with the City Zonin� Ordinance and may procerd a+ requcsted. Thrs dixvmrnt
whcn signrd by the Ciry PLinner constrtutes a temQurary Certificate of Zonin� compliance and aIIows canstruction tu commrnce. Before cxcupancy, a Ceraficate uf Occupancy must bc
issucd.
Planning Director Date S ial Condidons, if any
24 hour noticc for all inspections (952) 447-98Sp, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372