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oF PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
U �
'yjkNES��e' I White File pERMIT NO. �,
2. Pink City -
3 Yellow Applican�
Please e or rint and si at bottom
. ) ADDRESS ZONING (ot� use)
_�... � � c-�y ��� i�� � �tiZ� L����2
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER � yq �'
(Name) ��� `� (Phone) Z , `
(Address)
� BUII.,DER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE:�irR.C. ❑I.B.C. Misc. "V � �Q�� �
Type of Construction: I II III IV V A B pROJECT COST/VALUE $
Occupancy Group: A B E F H I M R S U
Division: 1 2 3 4 5 (excluding land)
1 hereby certi'ty that I have fumished information on this application which is to the best uf my knuwlcdge tnie and correct. I also certify that [ am the uwner or authonzed agent for the
above•mennoned property n at all constru ion will con to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
ufficial can revoke this per orjust cause. urt rmore, I er a ree that the c�ty official or a designee may enrer upon the property ro perform necded mspecuuns.
� X
Signamre Contracror's License No. Date
Permit Valuation �-Z 0� ,_. 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 $
This A i'on Becomes Your BuHding Pernut en pproved Paid '� Recei t
Date I B
Z
i�din � c)tlkia ac
This �s to certify that thc requcst in the above applicanon and accompanying documents is in accordance with thc City Zoning Ordinance and may protted as requcsted. Th�s document
when signed by the City Planner consntutes a tempurary Certificate uf Zonmg compliance and allows construction to commence. Before uccupancy, a Ccit�ficare of Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9R50, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372