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oF PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �.r. _� n ��
., � AND UTILITY CONNECTION PERMIT
U �
AIj p �D I Whice File
2 �;�� � PERMIT NO. _���
3 Yellow Applicam
Please e or rint and si at bottom)
ADDRESS ZONING (o� use)
�D P.� -S� t'2/ dr� ���-�
LEGAL DESCRIPTION (ofi'ice use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
BUII.,DER /� f�� O� � �
(Company Name) �y��� S��1E�''�� � �ie/�I� L.�i!c/ (Phone) ��z '�y / �
(Contact Name) ����I �"�f.S�Gi (Phone) ��Z° 5���' d6[�
(Address) ci/� ����Y �'!N . S�— �2 l Z �2�C� ` � �J �'
TYPE OF W�RK ❑ New Construction ❑Deck ❑Porch �e-Roofing ❑Re-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 $ v� ��
Occupancy Group: A B E F H I M R S U (exciuding land)
Division: 1 2 3 4 5
I hereby certif'y that 1 have fiimished information on this application which is w the best uf my knowledge true and correct. 1 also certify that I am the owncr or author�zed agcnt for thc
above-mennoned operry and that a(1 construction will conform to all exisnng state and local laws and will proceed in accordance with submitted plans. I am aware that the buiidmg
official can revo his permit for just ca Furthermore, I hereby agree that the c�ty official or a designee may enter upon the property to prrform needed mspectiuns.
X
ignature 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 cei t NO.
Date Z,� B .
Buildine Utlicial D�te
Thu �s to certify that the rcquest in the abuve applicanon and accompanying documents is in accordance with the Ciry Zoning Ordinantt and may proceeA as requcsted. Th�s ducument
when signed by the City Planner consututes a remporary Certificate of Zoning compliance and alluws construction tu commence. Before uccupancy, a CertificaM ��f Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour noticc for alt inspecNons (952i 447-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372