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oF PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
F ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE � p, / � /
.. X AND UTILITY CONNECTION PERMIT
U �
�, NNESO � c � I Whi1e File pERMIT NO. /�
2 Pink City
� i Yellow Applicam
Please or rint and si at bottom)
ADDRESS ZOIVING (ott'ice use)
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LEGAL DESCRIPTION (oflice use onty)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
BUII.,DER
(Company Name) �� ����` r• �t �. �c . (Phone) 76 3- 2 0 2- 6 3 S�6
(ContactName) ���.,�7•-� ,�r,���+ (Phone)
(AddreSS) r/u , r � �e .. {. �� �'v S � L
TYPE OF W�RK ❑ New Construction ❑Deck ❑Porch e-Roofin€ ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Conn tion /(� � ( � �'T'
T v f� �
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III N V A B pROJECT COST/VALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have fiimished information on this application which is w the best of my knowledge true and correct. 1 also certify that 1 am the owner or authonzcd agent for the
above-menhoned prope�ty and that all construction will conform ro ali existing stare and local laws and will proceed in accordance with submitted plans. I am aware that the buiidmg
oft�icial can revok his permit for just cause. Furthermare, I hereby agree that the c�ry official or a designee may enter upon the property to perform necded mspections.
X G- ? 0 3 2��y l(�- j y-l/
Signature Contractor's License No. Date
Permit Val ation 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 Application Becomes Your Building Permit When Approved Paid ReCe t No. c
Date , B
Buildin � (�t7icial Date
This �s to certify that the rcqucst in the abuve applicat�on and accumpanying documents is in accordance with the City Zoning Ordinantt and may prixerd as requcsted. This ducument
when signed by the Ciry Planner consututes a trmparary Ce�Yificate uf Zoning compliance and allows construction to commence. Before occupancy, a Ccitificate uf Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372