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o � PRI CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �,/�, � Z
AND UTILITY CONNECTION PERMIT
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'�'kN�so�`' � Wh;,e File PERMIT NO.�� , l�
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3 Yellow Applicant
Please e or rint and si at bottom)
ADDRESS ZONING (of�'ice use)
1 � �� /l���J- /G
LEGAL DESCRIPTION (of3'ice use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
(Company ��/U � Ci /�SC� ��'l�� . (Phone) ��Z" 8 yC� —'�d�
(Contact Name) �4�� ��2 SrE/�-rC� (Phone)
(Address) '��ld ,Q/Z��GGE �CE� 12�1G
TYPE �F WORK ❑ New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Conn tion
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 (excluding land)
Division: 1 2 3 4 5
1 h�7eby certify that 1 have (i�mished information on this application which is to the brst uf my knowledge tnie and correct. I alsu certify that I am the owner or authonzed agent for the
above-mennoned property and that all consh�uction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
official can revoke this permit fo e, I hereby agree that the c�ty official or a designee may enrer upon the property to perform necded m: cctiuns.
x ��.5`�� 0 7 �' -?/ ��
Signature Contractor's License No. ate
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 DLTE $ � �
This Applica ' n Becomes Your Building Perntit When Approved Paid Re t No. 2
Date B •
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B in_ Ufticial Date
Th�s is to certify hat the requcst in the above applicauon and accompanying documents is in accordance with the Ciry Zuning Ordinantt and may proceed as requcsted. This document
when signed by the Ciry Planner consnrotes a temporary Certificate of Zoning compliance and allows construction tu commence. Before occupancy, a Ccitrticate of Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372