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����P CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ` �� \ �' � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �. j �:' j ;;
"�.<' . _\_��,;' �' AND UTILITY CONNECTION PERMIT � �
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1. White F��e pERMIT NO.
2. Pink City � � . ) / G`.-�.
3. Yellow Applicant l
(Please or rint and si at bottom)
pDDRE$$ ZONING (otfice use)
�J � G' c�G� ��' JvC�
LEGAL DESCRIPTION (oflFice use only)
LOT BLOCK ADDITION PID
owx�R C l��'� M U�1..1" �� z- 7� �—!� f�
(Name) ""� '``t" (Phone)
(Address) ��d� � C. ��IN�Oc1�'G� �IJL� �,� LG\ �/.{G(l� n^�
(Company f�-��t�/� � � (Phone) �� � �� ���
(Contact Name) ��'�'� ��'�` t (Phone) �, 2 �Sy O/ �2
(Address) � U �« � 1� � S'�� v�O�— ���"�G� �� �
TYPE OF WORK ❑ New Conslruction �Deck �Porch �e-Roofing �Re-Siding OLower Level Fuvsh ❑ Fireplace
❑Addition DAlteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc:
'I�pe of Construction: I II IIT N V A B /
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $(� GUJ
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have fiirnished 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 ro erty and that all rnnstrucflon will rnnform to all elcisdng state and local laws and will proceed in accordance with sukmitted plans. I am aware that the building
official can re e thi pe:mit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perfoan needed inspections.
X �G �O -� ���2 y �� ���—
Signature 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 $ �, f
Tlus Application Becomes Your Building Permit When Approved P1id R ' t No. �
Date B
Buildin Official Date
T'his is to cemfy that the request in the above applicafion and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner consdtutes a temporary Certificate of Zoning compliance and allows construction to commence. Before ocwpancy, a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour noNce for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372