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oF rx� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� ��° � AND UTILITY CONNECTION PERMIT
U �
M��'NESD�P I. White File pERMIT NO
2. Pink Ciry �2 °���
3 Yellow Applicant
(Please e or rint and si at bottom)
ADDRESS ZONING (oftice use>
��l U�� �('� ���,�,� ('� ��' �'
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER e� �jI �' d� �' ) I�L(�
(Name) �y,r1 ���'`'e�"1 (Phone)
(Address) � �� ` / $ � ,y1(� �'�.. �. ;.:
BUII.,DER R�, '
(Company Name) Tki`'� C� '�i�e� f, J+ � f�f'0�lJ�� 0^,1 � (Phone) foS�" �� �y�(
(Contact Name) D°��t � �. ��� (Phone) �l ��`� ��{y
(Address) �p(� lL,r�'�f Q�c� � �� �� �kv1 /�'�nf � �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing , IZe-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. � Misc.
Type of Construction: I II III IV V A B pROJECT COST/VALUE $��
Occupancy Group: A B E F H I M R S U
Division: 1 2 3 4 5 (excluding land)
I hereby certify [hat I have Purnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authonzed agent for the
above-mentioned 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
official can revoke this pern ' rjust cause. Furthermore, I hereby agree that the ciry official or a designee ma enter upon the property to perform necded mspections.
x�o✓�'� � 12 � I�I t� � S-.�la- ��,.
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 DiJE $ 9� j
This Application Becomes Your Building Perntit When Approved Paid Recei t NO.
� Date B
.S3G/
Buildim� OYti�ial Date
This �s to certify that the request in the above applicauon and accompanying documents is in accordance with the Ciry Zoning Ordinance and may proceeA u requcstcd. This document
when signed by the Ciry Planner consututes a temporary Certificate of Zoning compliance and aAows construction to commence. Befure occupancy, a Certificate of Occupancy must be
issued.
Planning D'uector Date Special Condirions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4546 Dakota Street Prior Lake, MN 55372