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oF PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
y ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
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AND UTILITY CONNECTION PERMIT �' 7� Z--
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'dj�, I. whire File
2 �;�� c;, PERMIT NO. /� ��
3 Yellow Applican� {
Please e or rint and si at bottom)
ADDRESS ZONING (ot�ice use�
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
�aWNER �O � � C o�, v► f�Q � )�J ��2.r" (Phone) 1 � Z'" � y7� � �7
(Address)
BUII.,DER ��JL� �* L L C-. �� Z. _ �I [� -L'/���o
(Company Name) (Phone)
(Contact Name) (Phone)
(Address) g�` g� l�j � �T �� f7�"' L�r�
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. �] Misc.
S �' ���
Type of Constcuction: I II III N V A B pROJECT COST/VALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have fi�mished information on this application which is to the best uf my knowledge rrue and cortect. 1 also certify that I am the uwner or authorucd agent for the
abuve-mennoned property and that all cons ucti wiU conform ro all existing swte and local laws and will proceed in accordance with submined plans. I am aware that the buildmg
official can is permit for st caus . ereby agree that the ciry official or a designee may enter upon the property to perform needed mspections.
, G `� -/ Z
X ..
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 $
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This Applicallon Becomes Your Building Perntit When Approved Paid ei t NO.
Date B �
Buildin � Ufticial Date
Thu �s to certify that the requcst in the abuve applicahon and aceompanying documents is in accordance with the City Zoning Ordinantt and may protted as rcqucsted. Th1s document
when signed by the Ciry Planner consumtes a tempurary Certificate of Zoning compliance and allaws cunstruction ro commence. Before �xcupancy, a Ccitrticuc uf Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372