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, CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
�' �' ''\` � 9 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
~ ' '; ��
"�`�,<'�.....__;; \.�;%'�' AND UTILITY CONNECTION PERMIT
� _ ��
r '�'NES� �
1. White File pERMIT NO .
2. Pink City ^/
3. Yellow Applicant (,� /
Please e or rint and si at bottom
ADDRESS ZONING (oti'ice use)
5 S ,.,� �
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) ��}�..��c (Phone) RS 2 y 4 � •'I l �f
(Address) S
BUII,DER
(Company Name) Ca � ..� t � (Phone) � �'j . ^n9.1 ..3`l V t�
(Contact Name) �'l bb�f (Phone)
(Address) / (��'D �cr, i �'l (� N SS 2
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding �Lower Level Finish ❑ F'ueplace
❑Addirion ❑Alterarion ❑Utility Connection
CODE: �I.R.C. �I.B.C. �Iviisc: ��G.l.t. Z N,b�f�1S L�(SRl�ol �lkr r� f
Type of Construction: I II III IV V A B
Occnpancy Group: A B E F H I M R S U PROJECT COST/VALUE $ l200 ,
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have fumished inforcnarion on this application which is to the best of my lrnowledge true and correct. I also certify that I am the owner or authorized agent for the
above-mentioned property and that all construction will conform to all eacisting state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can oke this p it f just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property ro perform needed inspections.
X � �e1�Y2 � � '
Signature Contractor's License No. e
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 $
17us Application Becomes Your Building Permit Whett Approved Paid Re t NO.
Date B �
Buildin Official Date
This is to certify that the request in the above applicarion and accompanying documrnts is in accordance with the Ciry Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Direc[or Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372