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� � CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� D� TEMPORA.RY CERTIFICATE OF ZONING COMPLIANCE
" AND UTILITY CONNECTION PERMIT
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^` ��� / � 1. White File
2 . P; ,� � ;ty PERMIT NO jL ��
3. Yellow Applicant
lease e or rint and si at bottom
ADDRESS ZONING (ott'ice use)
1 ��� �f�KL1�1.�� eaC�n �2.
LEGAL DESCRIPTION (office use onty}
LOT BLOCK ADDITION PID
OWNER�,
(Name) l5r7?;rt�- .}- S�e n�2�(� (Phone) �S°Z ��7 �_
(Address) �/�Y(�
BUII..DER
(Company Name� jq �d r,`�-� s��� ,n�� �• c, �r�c _ (Phone) �Sa g 8� ss� a
(Contact Name) Tr � 1�ji ( � Y�5s5 �e.� (Phone) ' �C S—� ��5�
(Address) / � y� "
TYPE OF WORK ❑ New Construction �Deck �Porch ❑Re-Roofing [�Re-Siding �Lower Level Finish ❑ Firtplace
❑Addidon �Alterarion ❑Utility Connecuon 3 s�,� � ar t �c
CODE ❑�.R.�. o�.B.�. ❑ ��:
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 s f ��d �
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished informadon on this application which is to the best of my knowledge true and corred. I also certify that I am the owner or authorized agent for the
above-mentione roperty and that all construction wdl confoan to all eacisting state and local laws and will proceed in accordance with submitted plaos. I am aware t6at the building
official can rev is permit for just cau . Furthenpore, I hereby agree that the ciry official or a designee may enter upon the property to perfonn needed inspections.
x �C �F � 3v� c� I l�
Signature Contractor's License No. Date
Permit Valuarion 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 8c Water Permit Fee $ Other $
Gas Fireplace Perxnit Fee $ TOTAL DUE $ ,�
This Application Becomes Your Building Permit When Approved Paid Recei t
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 Ordinance and may procetd as requested. This document
when signed by the City Planner consdtutes a temporary Certificate of Zoning compliance and allaws wnswction to commence. Before occupancy, a Certificate oF Occupancy must be
issued.
Planning Dirxtor Date Special Conditions, if any
24 6our notice for all inspecHons (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372