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oF rR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
U �
���'N6S��� I. White File
Z �;�� � PERMIT NO. �Z _�.. �.
3 Ye�low Applican�
Please e or rint and si at bottom)
ADDRESS ZOI�TING (ofFice use)
D a o�Ds �' �-�-
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWrTER { / �4(" �
(Name) � F� �/LK� (Phone) (1/�� , �Gd 3
(Address) ,�7� f �!'�fl.S ��(�-rz !–IJ•
BUII.,DER ���.� ` �. � � �� �.
(Company Name) �l� (Phone) ���' �S 3v'�
(Contact Name) ��SJ?� Fj���2P (Phone) `Pl z -�7 Sf��c)
(Address) 7 3 2 ,S .,�u.'TTz�.J �.l�'��- �-�/ - Ju,�.l�
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch , e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utiliry 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 (excluding land)
Division: 1 2 3 4 5
I hereby certi' at 1 have ' ish d informati un this application which is to the best of my knowledge true and correct. 1 also certify that I am the owner or authonzed agent for the
above-me one prope and a(1 cuns iction will conform ro all existing state and local laws and will proceed in accordance with submined plans. [ 1m aware that the buildmg
official n rev e this r it �ust caus . Fu ermore, ! hereby agree that the city official or a designee may enter upon the property to perform necd •d ms •ctions.
X „��CG3�r Z3v � � �v
Si atu Contractor's License No. Date
ermit Valuation '"Z-� �� � Park Support Fee # $
Permit Fee $ "'� ^ SAC # $
.
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ i' 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 $
r�
This A ati Becomes Y�ur Building Permit Whe Appr ed Paid Recei t NO.
Date B
C�
Buil i "cial D e
Th�s u to certify that the requcst in the abuve applicanon and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requcsted. This dexumem
when signed by the City Planner constuutes a tempurary Certificate of Zoning compliance and aAuws construction tu commence. Befure oceupancy a Certrficam of Occupancy must be
ISSUI`d.
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