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� � CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" `� AND UTILITY CONNECTION PERMIT
�
j �'NES O �
�. we;�e File PERMIT NO. �Z -3, /�
2. r;nt c�ry �
3. Yellow Applicant �F
lease e or rint and si at bottom)
ADDRESS ZONING �o�tt ��>
I 4 z.z.8' Sl�o�-� L,,, n1 • E.
LEGAL DESCRIPTION (oflfice use only)
LOT BLOCK ADDITION PID
(Na �v�r�lv /�'� "lQ ✓� `�no� ✓�e .� (Phone) � � Z '� � g� - `o � Z�7
(Address) f � Z.Z g �� °'Q � �^ �' � �
BUII.,DER 1 q
(Company Name) — l,� � � � '� 4 � �"� � • (Phone) /-SZ � � � 6 '� � ��a
(Contact Name) /2� c� �c�.•� a� (Phone) �o ( Z - � �� � g � 9
(Address) �3oI E. C��� �� �'//7 �,✓•.Sv� ��Q, MN ��33�
TYPE OF WO� ❑ New Construction ODeck ❑Porch "�e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fit+eplace
❑Addition ❑Alteration ❑Utiliry Connection
CODE: ❑I.R.C. ❑I•B•C. O 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 $ ����
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished informarion on this application which is to the best of my lrnowledge we and co:rect. I also certify that I am the owner or autMoriud agent for the
above-mentioned property and that all constxuction will conform to all existing state and local laws and will proceed in accordance with submitred plans. I atn aware that the building
official can revoke thi ermit or just use. hermo ereby agree that the city official or a designee may enter upon the property to perfonn needed inspectiona.
X �'C �s6 8� 7 S/Z /i Z
Signature Contractar'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 DiJE $ , 7
T6is Application Becomes Your Building Permit When Approved Paid ReCel t
Date �
Buildin Official Date
This is ro certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requeaoed. 7his document
when signed by the City Planner rnnstitutes a temporary Certificate of Zoning compliancre and allows conswction to wmmence. Before occupancy, a Ceitificabe of Occupancy must be
issued.
Planning Director Date Specinl Condi�ions, if any
24 hour notice for all inspections (952) 447-9850, faz (952) 447-4245
4646 Dskota Street S.E., Prior Lake, Minnesota 55372