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oF PRtp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE � Z� / Z
� x AND UTILITY CONNECTION PERMIT
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��NNEB��� 1. Whi�e File
2 �;,,k c;, PERMIT NO. r Z. Z3
3 Yellow Applicam
Please or rint and si at bottom
ADDRESS ZONING (otfice use>
� ��
LEGAL DESCItIPTION (office use only)
LOT BLOCK ADDITION PID
OWNE Q l ' t�
(Name) � �- (Phone) - 1 SZ— "1 �� � 1� �
(Address)
BUII.,DER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Conne o
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Constiuction: I II III IV V A B pROJECT COST/VALUE S
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereb ertify that 1 have fumished information on this application which is w the brst of my knowlcdge true and correct. I also ceRify that I am the owner or authonzed agcnt for thc
above-m ned pr •rty h 11 cunstruction will conform ro ali existing state and local laws and will proceed in accordance with submined plans. I am aware that the buildmg
official ca ke t is permit ju cause Furthermore, I hereby agree that the c�ty official or a designee may enter upon the property to perform needed i specti ns.
x Z ���—
Signa re Contractor's License No. ate
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 DUE $ �
This Application Becomes Your Building Permit When Approved Paid • ' t No. Z--�
Date
BuilJin � Utiicial Date
This �s to certify that thc requcst in the above applicat�on and accumpanying documents is in accordance with thc Ciry Zoning Ordinance and may pr�xeed as rcqucsted. Th�s dixument
when signed by the Ciry Planner constitutes a temporary Certit'icate uf Zoning compliance and alluws construction ro commence. Befure occupancy, a Certrticate of Occupancy must be
issued
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9SS0, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372