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oF PRtp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
U �
'�j I. White File
2 �;�, � PERMIT NO. �Z _���/
3 Yellow Applican[
Please e or rint and si at bottom)
ADDRESS ZONING (of�ice use)
� tJ U � �-�-o/ _
LEGAL DESCRIPTION (oflEice use only)
LOT BLOCK ADDITION PID
OWNER �` • / c
(Name) c� (Phone) (�'�7 �c� �'' O�
(Address) (�� I �OS '�� �w C\(� �(�j,W�-
BUII.,DER - L � C� �p � d- ��a'�-�dJ
(Company Name) 1�21 OM �� (Phone)
(Contact Name) (Phone) � � �- �' o�-� �
(Address) (� - � � +a' M
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Urility Conne ion
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III N V A B pROJECT COST/VALUE $ 1�`'��
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I herrby certi'ty that I have fumished information on this application which is ro the best uf my knowledge true and correct. I also certify that ( am the owncr or authonzed agent for thc
above-mennoned roperty and th all construction wiil conform to all existing stace and locai (aws and will proceed in accordance with submitted plans. I am aware that the buildmg
official can revok is per 't for us cause. Fu ermor hereby agree that the ciry official or a�ee m� enter upon� e propercy to perform needed mspecuons. I
X C y�7 y Z�' �
gnature Contractor's License No. Date
Permit Valuatio Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; I"; $
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 Whrn Approved Paid . ReCei t N.,
Date B
Buildine Ufticial Date
Th�s �s to certify that the requcst in the abuve applicauon and accompanying documents is in accordance with the Ciry Zoning Ordinance and may proceed as requcsted. Th�s ducument
when signrd by the City Planner consnm[rs a temporary Certificate of Zoning compliance and aUows construction ro commence. Befure uccupancy, a Ceruficah 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