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o� ; ,, pR��•p CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
F; '� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
U � AND UTILITY CONNECTION PERMIT
M �NNES�� P
l. White File pERMIT NO .
2. Pink City
3. Yellow Applicant
Please e or rint and si at bottom
ADDRESS ZONING (ot�ice use)
�3�U ,(��l�o�a4 �'� S,� `
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER , Jr /�
(Name) �r�//I��1'r ZA!�l��iC�� (Phone) qSo�- ��o S'" ��{��
(Address) � � � ,� /y �qr
BUILDER, � /�
(Name) G(O/� 0l.1� L=J�L i��/�/�.°.50�9 (Phone) �� �OS �d/DS
(Contact Name) �/iCG .���rrrA�- (Phone) �,ura_
(Address) y{�a ��� Dr /,. � /�� r_�� S /
CY G
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding
❑Lower Level Finish ❑ Fireplace ❑Addition ❑Alterarion ❑Utility Connection
Misc. ,� / �Ql�$ , S�/K ROJECT COST/VALUE (excluding land) $ �Q
I hereby certify that I have fumished informarion 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-menrioned property and that all construcdon will conform to all existing state and local laws and will proceed in accordance with
submitted I am a are at the building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
enter up r e o orm needed inspections.
X ac�i�3y93 �/��/��
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 $ City SAC and WAC # $
Plumbing Pennit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ .�S
This Application Becomes Your Building Permit When Approved Paid Re t NO.
Date . 2 ,, B
Building Official Date
This is to certify that the request in the above application and accompanying documenu is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner consritutes a temporary Certificate of Zoning compliance and allows conslruction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date Speciai Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372