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��� P CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � /; 1� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Z ��
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C__......a _._._...__ AND UTILITY CONNECTION PERMIT
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1. White File pERMIT NO . �� —� .(
2. Pink Ciry
3. Yellow Applicant ✓
tease e or ' and si at bottom
ADDRESS ZONING (oflice use>
l �c�� �P��l Id �, ��,
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OW /� �' � / L.� � L. � �� � � (Phone) / � ��� 7 " / ��
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(Address) � �� � � � �" � N �v � /�l ,
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BUII,DER �
(Company Name) � � �- � L1 `J (�t.0 T �Ql�-� (Phone) l� l o`� 'o� � �D — � � � �
(Contact Name) ���L 7�/ L/ C H (Phone)
(Address) .�� ���C� � � /� • ��—� /�1 7�'� ��. � /�!
TYPE OF WORK ❑ New Construction ❑Deck �Porch ° �e-Roofing �Re-Siding ❑Lower Level Finish ❑ Fireplace
'❑Addidon ❑Alteration ❑Utility Connection
CODE: �I.R.C. DI.B.C. ❑ Misc:
Type of Consmution: I II III IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COST/VALLTE $
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have famished information on this application which is to the best of my ]mowledge true and waeM. I also certify that I am the owner or authorized agent for the
above-mentioned pmperry and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am awaze d�at the building
official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon ffie property ro perform needed inspecdons.
X �C�o�Cv 8'7 �
Signature Contractor's License No. Date
Permit Valuarion �� Park Support Fee # $
Perxnit 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 PermitFee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $
This Application Becomes Your Building Permit R'hen Approved Pa id R t No.
Date
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 proceed as requested. This document
when signed by the Ciry Planner constitutes a temporary Certiflcate of Zoning compliance and allows construction ro commence. Before occupancy, a CertiScate of Occupancy must be
issued.
Planning Director Dat¢ Special Condidons, if any
24 hour noHce for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372