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o � PR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
F ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
.. X AND UTILITY CONNECTION PERMIT �` � ���
U �
�'�Nrreso�° i wn��e File pERMIT NO �
2. Pink City �� f ��
3 Yellow Applicant ��
Please or rint and si at bottom)
ADDRESS j ZONING (o� use)
I��i J�0 �(Q,�,1� S,(�L C..� C(,'�
LEGAL DESCRIPTION (of1'ice use only)
LOT BLOCK ADDITION PID
OWNER (� ,
(Name) ��p 1"1 b� 1� � Gl (Phone)
(Address)
BUII.DER , � b I d �� S 3
(Company Name) . � o � � (Phone) � �
(Contact Name) A�1L SQ�N (Phone)
(Address) � 's � q � �v �`�' ��� �f iJ� � N IaO�
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch - oofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utiliry Conne on
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
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 (excluding land)
Division: 1 2 3 4 5
I hereby certity that I have fumished information un this application which is w the best of my knuwledge true and correct. I also certify that I am the e�wncr or authonud agent for thc
above-mennoned property and that all construction will conform to all existing state and local taws and will proceed in accordance with submincd plans. I am aware that the buildmg
official can rrvoke this per t for just cause. Furthermore, I hereby agree that the ciry official or a desi ee m enter upon the property to perform necded mspectiuns.
X �� ��o ��y I� ���, ��
Sign re 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 $ Cf
.
This Application Becomes Your Building Pemtit When Approved Paid ei t No.
Date B
BuilJim� Utiicial Date
Th�s �s to certify that the request in the above applicauon and accompanying documents is in accordance with the Ciry Zoning Ordinance and may protteA as requcsted. Th�s document
when signed by the Ciry Pianner consututes a tempurary Certificate of Zoning compliance and allows consrruction ro commence. Before occupancy, a Certificate uf Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour noticc for ail inspections (9S2) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372