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oF PR��� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE /D . j.�'.�, � Z
� � AND UTILITY CONNECTION PERMIT
~ �1yp�Sp'�� I. Whi�e File PERMIT NO
`-_'—'� 2. Pink City �_� . . I �. ���
3 Ye�law Applicent �
Pleax or 'rtt and si at bottom y
ADDRESS ZONING (o�t'ice use>
3 W �� �
LEGAL DESCRIPTION (ot�ice use only)
LOT BLOCK ADDITION PID
°'�R G � ��' 7 -3lCo l
(Name) � ��l:d lr( la i�'9 Q � (Phone) ��_ �
(Address) �(Q � �i�/ tk' � ^� •
BUII,DER � �5�� Y�oL " � ( �4
(Company Name) (Phone)
(Contact Name) �"1 * (Phone)
(Address) � � Oc� 7' ' /lf R./ s��
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e•Roofing ❑Re•Siding ❑Lower Level Finish ❑ Fireplace
❑Addition �Alteraaon ❑Ualiry Connectio
CODE: []I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B pROJECT COST/VALLTE $
Occupancy Group: A B E F H I M R S U (exciuding land)
Division: 1 2 3 4 5
I hueby certify that [ have fumished information un thu applicatiun which is tu the best of my knowicdge nve and correct. [ atsu certify that I am the ownc7 or author�zed agent for the
above-menttoned property and that a(1 cunstruction wili conform to ali exiscing state and tocal laws and wiil proceed in accordance with submitted plans. I am awaze that the buiidmg
uflicial can revoke this mit for jusc ca se- Furthermore, I hereby agee that the ciry officiai or a designee may enter upon the property to perform necded iatipectiuns.
X
Si ture Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan 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 $
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This Application Becomes Your Building Perntit Whea Approved pa�d � ei t NO.
Date U, s i L_
Buiidin � Ottici:d Dnte
Thu is to certify that thc requcst in the above appticahon and accumpanying documents is in accordance wich the City Zonin� Ordinance and may pr�ceed ae rcqucsecd. Th�s document
when signed by the City PLinner conshtutes a tem{wrary Certificate uf Zoning compliance and aliuws cansm�c[ion tu commence. Before cxcupancy, a C��ruticare of Occupancy must be
issucd.
Planning Directar Date Special Conditions, if any
24 hour noticc for aii inspections (9S2) 447-985(i, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
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