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oF PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� AND UTILITY CONNECTION PERMIT � '" �o�'
U �
y�NNE3��� I. Whi�e File PERMIT NO �cS
2. Pink City
3 Yellow Applicanl J
Please or rint and si at bottom
ADDRESS � ZOI�TING (ot�'ice usc)
��� 1�O�SS � 0 0� C� r�,,( S�
LEGAL DESCRIPTION (office use onty)
LOT BLOCK ADDITION PID
� ��\ C � J� O � � (Phone) �7� V T�� � � U �
1" �
(Address) s (��� �' ,S �,,� ��
BUII.,DER ' �n1' r j17� � \.x � � ' aa�
(Company Name) r S (M� (Phone)
(Contact Name) �(' �. (Phone)
(Address) �. ��_
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing e-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition �Alteration ❑Utility Connection
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 5
I h�reby certify that I have fumished information un this application which is to the best uf my knowlcdge true and correct. 1 also certify that I am the owncr or authonzcd agcnt for the
abuvc-mentioned property and that all cunstniction will conform to all existing state and local laws and will proceed in accordance with submittcd plans. I am aware that thc buildmg
offic' I ca evoke this permit �ust cause F rthermo I hereby agree that the city official or a designee may enter upon the property ro perform necded mspections.
X �C,� �-�� �� �-�1
Signature ContraMOr's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ 7( � 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 DiTE $ '7 ,
This Application Becomes Your Building Permit When Approved Paid � ReCel t NO.
Date '- — B
�
Bi � m�� Utlicial D� e
This is to certify that the requcst in the abuve applicanon and accumpanying documents is in accordance with thc Ciry 7.�>ning Ordinance and may proceed as requcsted. This dixument
when signed by the City Planner consumtcs a temporary Certificate of Zoning compliance and allows construction tu commence. Befure uccupancy, a Certificate of Occupancy must be
issucd
Planning Director • Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9R50, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372