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oF PRi CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �? ��
� AND UTILITY CONNECTION PERMIT � �
U �j
��'�'NESO�� I. White File pERMIT NO . ,r r--
2. Pink City / � , � �
3 Yellow Applicam � 7
Please or rint and i at b om)
ADDRESS 0 � '� �,+ �� � ZONING (o� use)
l ..
I
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
�aWIVER ��'`� � (Phone) ��b'-�7�
(Address) l �� � �/lC}� �r
BUII..DER (
(Company Name) IQ.C.1 � '�-S L� (Phone) ��'0
(Contact Name) (Phone)
(Address) "� � �(Y3t�hG�aO� �T
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. O Misc.
Type of Const�uction: 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: I 2 3 4 5
I hereby certify that [ have fi�mished infi�rmation on this application which is to the brst of my knowledge tnie and correct. 1 alsu certify that I am the owner ur author�zed agent for the
abuvamennoned p perty and that all construction will conform ro all existing stace and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
oFficial can revoke t permit or ause. ermore, I hereby agree that the city offici�a���� a��_ gon the prope[ry to perform necd��pec ions. ,
X
1 � ��2
Si ature 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 Permit When Approved Paid ,.�'� Re t NO.
Date B -
Buildine Uf'ticial Date
Th�s �s to certify that thc requcst in the abuve appiicatian and accompanying documents is in accordance with the City Zoning Ordinanec and may prixeed as requcsted. Th1s document
when signed by the City Planner consututes a temporary Certifieate of Zoning compliance and aUows construction tu commence. Before uccupancy, a Ceruficate of Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9850, fxx (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372