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o � PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
U �
~�NNeSO�� I. White Fil � PERMIT NO. r ,3 ��
2. Pink Cit �
3 Yeliow Applicant
Please or rint and si at bottom
'� ADDRESS ZONING (ot�ice use)
� /l J�7 L �I ?/2 G G L �. � •
LEGAL DESCRIPTION (oflf'ice use only)
LOT BLOCK ADDITION PID
OWNER p �/y� �/
(Name) D / / � � �'1 �t--- (Phone)
(Address) � I�(' 1� ►2 � � C -
(Comp ny ��� v � �J��l1�.rt�J � (Phone) �� �' .� g � � � � ��
(Contact Name) _�� � � �rp� (Phone�� — ��— � � ��
(Address) �p0 C d i p Z(/V � �"
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch : e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Urility Connec ion
CODE: I.R.C. ❑I.B.C. � ❑ Misc.
Type of on ion: 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
1 hc7eby certify that I have fumished information un this application which is to the best of my knuwlcdge true and correct. I also cenify that I am the owncr ur authonzed agent for the
abovamenn ed property an that all construction wiil conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that thc buildmg
ufficial can rr ke thi permit or just cause. Furthermore, I hereby agree that the city official or a designee may enrer upon the property ro perform needed mspect�ons.
X �c_ Co�7a7� � � ��-
Signature Contractar's License No. Date
Permit Val ation � Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ — Pressure Reducer $
r
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 1' tio Becomes Your Building Permit Wh Approv d Paid ReCei t NO.
Date B
Buildins Utlicial nte
Th�s �s to certify that the requcst in the abuve applicauon and accumpanying documents is in accordance with thc Ciry Zoning Ordinance and may proceed as requcsted. This document
when signed by the City Planner consntutes a tempurary Certificate of Zoning compliance and alluws construction to commence. Before ucciipancy a Cert�ticah i�f Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (9S2) 447-9850, fax (952) 447�4245
4646 Dakota Street Prior Lake, MN 55372