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oF ret CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ���� Z
.. � AND UTILITY CONNECTION PERMIT
U �
��NNesa�� � Wn��e File PERMIT NO. I� ��
2. Pink Ciry 6
3 Yellow Applicant
Please or rint and si at bottom)
ADDRESS ZONING (otTice use)
�5� z ��r �r. P�,� �
LEGAL DESCRiPTION (ofFice use only)
LOT BLOCK ADDITION PID
OWNER (� M
(Name) L/C L 1�,,, /�/ R G,�'p N (Phone)
(Address) � 7
BUII.,DER
(Company Name) �-- (Phone) 9 r� - 4'1 � -�r y��
(Contact Name) ll_ (Phone)
(Address) '"1 t�G . t /� C S'r3� z.
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �te-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Urility Connecnon
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 S
I hereby certify that I have ti�mished information on this application which is ro the best uf my knowledge true and correct. I alsu certify that 1 am the uwner or author�zcd agent for the
above-mentioned proprrty and that all construction will conform ro all existing stare and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
official can revoke this permit f r just cause. Furthermore, I hereby agree that the city official ur a designee may enrer upon the property to perform necded inspechons.
x /3 e- 6� 7 l i '�' - � r-12
Signa re 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 Yow Building Permit When Approved Paid `� ei t NO.
Date
BuilJin � Utlicial Date
Thu �s ro certify that the requcst in thr abuve applicauon and accumpanying documents is in accordance with thc Ciry Zoning Ordinance and may pri�ceed as requcsted. Th�s ducument
when signed by the Ciry Planner cunsurotes a tempu�ary Certificate of Zoning compliantt and allows construction to commence. Befare �xcupancy, a Ceruficam of Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372