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a � re� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
U �rj
'a►j�, 1. White File pERMIT NO.
2. Pink City � Z ,���
3 Yellow Applicant
Please e or rint and si at bottom)
ADDRESS ZONING (ott'ice use)
r s�2O � iG {Lk �,��
LEGAL DESCRIPTION (oFlf'ice use only)
LOT BLOCK ADDITION PID
(Na�m E �G�C� ,bN Av`� (Phone)
(Address) �` SA w�.�- � �
BUII.,DER �� i �
(Company Name) �� �. � (Phone) �,'� ���' ��� , t
(Contact Name) ✓� � 1. (Phone) �ij� �-' � �— " � � q �
(Address) � q �L q Zt � �" G�u� " �Gu1 I � ��d �/y
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Urility Conn io
CODE: ❑I.R.C. ❑I.B.C. � Misc.
Type of Constcuction: I II III IV V A B pROJECT COST/VALiTE $
Occupancy Group: A B E F Ii I M R S U
Division: 1 2 3 4 5 (excluding land)
1 hereby certify that I have fumished information on this application which is to the best uf my knowlcdge true and correct. I also certify that ! am the uwner or amhunzed agent for thc
above-menaoned property and that all construction will conform to ali existing stare and local laws and wili proceed in accordance with submitted plans. I am awarc that the buildmg
ofl'icial can revoke thi er rt f just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed cpections.
X L,�� �C S"� � 8�1'3 ��0 I� � 1 Z..
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 $ 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 Pernut When Approved Paid Recei t
Date /Z. B
Buildine Ufticial Date
Th�s is to certify that thc rcqucst in the abuve applicatton and accompanying documents is in accordance with the City Zoning Ordinance and may prnceed as rcqucxted. Thls documcnt
when signed by the City Planner constitutes a tempurary Certificate uf Zoning compliance and allows construction tu commence. Befure occupancy, a Ceruticuc of 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 Daicota Street Prior Lake, MN 55372