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of PR/04, CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
.. AND UTILITY CONNECTION PERMIT �" Z
U P,
M1A'NEsolP I. White File
2 Pink City PERMIT NO. `s z,
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS /�_ l ZONING(office use)
/ ? , b B v<—;-.5)
� �c15 5k _ S J e; l.,r-- ..c...1(..i2
- LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
4_ OWNER .....--1
(Name) % ,r--._ `-'s- \
. (-\--4 ...., t \ a`,„—) (Phone) t-4,4, O — cc)O'.'I H
(Address) 3.)._ b c5 e.),--- JS 5k SL.,) Pr: L.c.,—V1.4._
Pr:,), '
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace
❑Addition ❑Alteration DUtility Connection
CODE: pdt.C. ❑LB.C. 'Mise. fir'y512p
Type of Const action: I II III IV V A BC C+
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ i
(excluding land)
Division: 1 2 3 4 5
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above-mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke this permit for Just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
Signature Contractor's License No. Date
Permit ValuationZ� ®� --- Park Support Fee # $
Permit Fee $ Ti;1'7 SAC # $
Plan Check Fee $ II , 14- 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 DUEg2//�:e��p�2 J�} 4.. /4, ` $ ( 12-.621
This Applicata t B 'mes Your Building Permit ' en ' ,proved Paid /2-2....h. % ceipt No. /
06
0 I ,-- Date ¢ /7,/S'
.'ui din,Oftr D, e
This is to certify that the request in the above application and accompanying docu nts is i ccordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the P er constttut s a temporary Certificate of Zoning co pliance d allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued.
ii) /.5-
1 nning Director ate Special Conditions,if any
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372
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