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� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� °" AND UTILITY CONNECTION PERMIT
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l �'N S S��
1. White File PERMIT NO . 1 � . Z�/
2. Pink Ciry
3. Yellow Applicant
lease e or rint and si at bottom
ADDRESS ZONING (ot�'ice use)
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LEGAL DESCRIPTION (ofT'ice use only)
LOT BLOCK ADDITION PID
OWNER /
(Name) ������ � �� (Phone) /�e /i�— �cP�"� ���
(Address) ��Cq �� ���_.__.__� _ _._ ..__.._._ ._._
BUII,DER �
(Company Name) �/�ru�r'lCi� COV �t13'� � 1�yt y�jp�1 (Phone) �1 °�'�S�'� 10�
(Contact Name) �I �g � WI �Q.r.� (Phone) � Cv(��' $��0�7
(Address) / • l�t�t� � ;S. /
TYPE OF WORK ❑ New Construction �Deck �Porch ORe-Roofing �Re-Siding []Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
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CODE: ❑I.R.C. �I.B.C. j�l Misc: �11
Type of Construction: I II III N V A B p
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ Rj �!��
Division: 1 2 3 4 5 (excluding land)
I hereby certify th I have furnished ' formadon on this application w6ich is to the best of my knowledge true and correct. I also certify thaz I am the owner or authorized agent for the
above-mentio d a construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am awaze that the building
official c e is t f ' rthermore, I hereby agree that the ciry official or a designee may enter upon the property to perform needed inspections.
X �L/���1 q3 .3�� l��
ignatur Contractor's License No. Tr 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 Perxnit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DiTE $
This Application Becomes Yo� Building Permit When Approved Paid R e� t No.
Date „ < <��
Buildin Official Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the Ciry Planner constitutes a cemporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Plaoning Director Date Speciai Conditions, if any
24 hour notice for all inspecNons (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372