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oF PR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �� � f Z
.. � AND UTILITY CONNECTION PERMIT
U �
�,�NES��° I White File pERMIT NO. 1 Z �� �
2. Pink City
3 Yellow Applicant
Please e oc rint and si at bottom)
ADDRESS ,� ZOI�TING (ottice use)
� c i� �� ' ��
LEGAL DESCRIPTION (oFlf'ice use only)
LOT BLOCK ADDITION PID
OWNER �(J� I
(Name) / ' � �v`°e � ��''� � (Phone)
(Address) ` � 2 d�L� S e- Ll.� � � � �
BUII.,DER /� ?
(Company Name) �- (� � S "��/� rt � U� �� (Phone) �S� �✓ 7 � �
(Contact Name) 4� (Phone)
(Address) /� �F t��, � �.3
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Conn ion
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III N V A B pROJECT COST/VALUE $ �d Q �
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that 1 have fumished information on this application which is to the best of my knowicdge tn�e and correct. 1 alsu cenify that I am the owner or authonzrd agent for the
abuvamennoned property and that all cunstruction will conform ro all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
ufficial can revoke this p'mit for just ca e Fu rmo hereby agree that the city official or a designee may enter apon the property ro perform necdcd ms ecuun .
X �C�������� � 2
Signamre Conuactor'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 DLTE $
This Apptication Becomes Your Building Permit When Approved Pald i t NO.
Date < <
BuilJine Ut7icial Date
Th�s is to certify that thc rcqucst in the abuve applicatwn and accumpanying documents is in accordance with the Ciry Zoning Ordinantt and may proceeA n requ��ted. Th1s dixument
when signed by the Ciry Planner consntutes a remporary Ce�Yificate of Zoning compliance and allows construction tu commence. Before occupancy, a Crruficate uf Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspcctions (952) 447-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372