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F 9 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" "' AND UTILITY CONNECTION PERMIT
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j `�'N E S ��
�. ��� File pERMIT NO.
z. P� �,�Y � Z _
3. Yellow Applicant
lease or rint and si at bottom)
ADDRESS � � Z � �� � �, ZONING (otfice use)
LEGAL DESCRIPTION (ott'ice use only)
LOT BLOCK ADDITION PID
OWNER
(Name) �A�Q �e � (Phone) � � Z ' 3 `� �o - S�/ 70
(Address) �S S� 2 ..s �c Ol ��t � .1�/
BUII,DER ,
(Company Name) ��' �' � " , T - , •� � . (Phone) 9'-SZ ' 75�6- 3 o S� 6
(Contact Name) �'� SG�w�-� (Phone) �o � Z - `/ �g (� $'7 `�
(Address) � 30 � C. � ���� �� �//7 u✓�S� � � P � � 5� `7
TYPE OF WORK � New Construction ❑Deck ❑Porch �Re-Roofing Q�lte-Siding QLower Level Finish ❑ Fireplace
�Addition �Alteration ❑Ualiry Connection
CODE: DI.R.C. �I.B.C. p Misc:
Type of Construction: I II III IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ 3 �/ �
Division: 1 2 3 4 5 (exclnding land)
I haeby certify that I have furnished information on this application which is ro the best of my Imowledge true and correct. I also cettify that I am the owner or suthoriud agent for the
above-mrndoned property and that all rnnstruction will conform to all existing state and local laws and will proceed in accordsnce with submitted plans. I am aware that the building
official can rev e th' pemtit for j t cause. re, I hereby agree that the city official or a designee may encer upon the property to perform needed inspections.
x � ,gC. `/SO S� 7 �f /z S/� Z
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 Petmit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DiJE $ , 7�
This Applicarion Becomes Your Building Permit Whm Approved Paid Recei t O.
Date B ,
Buildin Official Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinaaa and may proceed as requested. This document
when signed by the City Planner rnnsrirutes a temporary Certificate of Zoning compliance and allows construction to wmmence. Befoxe occupancy� a Certificace of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, faz (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 53372