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oF PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
v �,
•'yI�,NES��P 2 Pin �';� PERMIT NO. �
3 Yellow Applicant /+� ��� � �� /
Please or rint and si at bottom
ADDRESS ZONING (ot�'�ce use)
/1..� 1��,�5 .S � f"'� f>k�--1 , � r S L.'-�i fc�....-,
LEGAL DESCRIPTION (oflfice use only)
LOT BLOCK ADDITION PID
OWNER /�,,� ,���•` // 7
(Name) �C9� � l�-�" �L t�-�-'� �--�Q,� �� (Phone) CPl � - 7/� - �J°? �
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(Address) �� `v' � � f'� � �� C1CX- c5 � ��UO2 _ �7� �JJ'�v� ��
BUII..DER ���C� �i /C. Ll �l ' �CS �` �Ce Y �
(Company Name) C (Phone)
(Contact Name) G (Phone)
(Address) L-� � � r C.� � a Q�G�=fc.e� /�??/� ��� ��
�YPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re•Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection t �
CODE: DI.R.C. �I.B.C. �Misc. r��.�l?a��� 1'U�)��
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
1 hc�reby ceRi(y that 1 have fumished information on this application which is to the best of my knowledge true and correct. i also certify that f am the owner c�r authonzed agent Por the
above-menuoned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
ofTicial can r voke this per it for just cause Fwthermore, I hereby agree that the city ofFicial or a designee may enter uppn the property to perform necded mspections.
X�i� �llrr�� C'� X�/��� y� 30- ��
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Pian Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
�'enalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Iulechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $
This Application Becomes Your Building Peimit Whm Approved Paid � ReCei o. .S
Date .�� , / 2.. B _
Buiidin Otiiciai D�te
This �s to certify that the request in the abovr application and accompanying documents is in accordance with the Ciry Zuning Ordinance and may proceed as requestcd. This ducument
when signed by the City Planner conshtutcs a temporary Certificate of Zoning compliance and allows construction to commence. Befure occupancy, a Ccrtificate of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, iax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372