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oF rR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
F ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE / ��� �/
.. � AND UTILITY CONNECTION PERMIT
U �
���'NES��� 2 � �'► �; Y PERMIT NO. `� - ��� fD
3 Yellow Applicant
Please or rint and si at bottom)
ADDRESS ZONING (of�ice use)
3 a� r� a< <o
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER �,
(Name) T.,,�, Fi2 ffr.�.o� (Phone) 9��y�I7 - ��_
(Address) 6 S�
BUII,DER
(Company Name) oo��jl ��,�5 (Phone) 7�3—��� � 9.�
(Contact Name) , .4u� o /l�,,R,�L� (Phone) S4 �C
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Uriliry Connection
CODE: ❑I.R.C. ❑I.B.C. � Misc.
Type of Construction: I II III N V A B pROJECT COST/VALLTE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hcreby certify that f have fumished information on this application which is to the best of my knuwledge true and mcrect. I also certify that 1 am the uwncr or authonzcd agcnt for thc
above-mennoned property and that all construction will conform to all existing stace and local laws and will proceed in accordance with submittcd plans. I am awarc that the buildmg
official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform necded mspect�ons.
x Q.-Q•�.�i�.� �lQ�7 So� /T ���--
Signamre 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 r $
,
This Application Becomes Yoar Building Pecmit When Approved Paid �' el t NO. "�' `
Date C� . B ,
BuilJins Utliciai Date !
t,
This �s to certify that the request in the abuve applicahon and accompanying documents is in accordance with the Ciry Zoning Ordinance and may proceeA as reqacsted. Thls document
when signed by the Ciry Planner consumtes a temparary Certificate uf Zoning compliance and allows construction tu commence. Befure occupancy, a Ceruficate uf Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372