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oF ry pRt o � CITY OF PRIOR LAKE BUILDING PERMIT, � Date Rec'd
� 9 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT � ` � � �
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M ��'NES�� P � 2. 1'iok ��� � PERMIT NO. Z ��,
3 YeUow qpplicartt �
Please e or rint and si n at bottom)
ADDRESS .�,��� ZONING (ott'ice use)
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LEGAL DESCRiPTION (of�'ice use only) `•''
LOT BLOCK ADDITION PID
OWNER � �Q
(Name) (Phone) � �[ X�„�, f�,�
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(Address) l
BUII.,DER �
(Company Name) �.lG- �.00�itx� o-r�rl� �'�e. c� (Pnone� a5`a - Gi5 - `1a,aSo
(Contact Name) �e.ahnc. �,�,��� (Phone)
(Address) � t (j �,�c(�,\Si O'�' 1 �- . �S 4vµ V(1�J ��J� ��o
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alterarion ❑Utility Connec on
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III N V A B pROJECT COST/VALLTE $�Z,ZZ
Occupancy Group: A B E F H I M R S U
Division: 1 2 3 4 5 (excluding land)
I hereby certify that [ have tumished information on this application which is ro the best of my knowledge tnie and correct. I also certify that I am the owner or author�zed agent for the
above-ment�oned proper ^" •..�.'--�°":� tion will onform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
ufficial can revo err�'t for just c< urther y agree that the city official or a designee may enter upon the property to perform necded inspections.
X ` � `���
Contractor's License No. D te
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 DiJE $
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This Application Becomes Your Building Permit When Approved PSId R i t NO. f Z
Date B ,
Buildin_ UtTicial 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 proceed as requc�sted. This document
when signed by the City Planner constnutcs a temporary Certificate of Zoning compliance and allows consnvction to commence. BePure occupancy, a Ccrtificatr of Occupancy must be
issued.
Pianning D'uector Date Special Conditions, if any
24 hour notice for All inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372