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oF PR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
F ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �-- � 4 y ��
.. � AND UTILITY CONNECTION PERMIT
U �
'4j� 1. White File pERMIT NO.
2. Pink City �
3 Yellow Applicant
Please or rint and si at bottom)
ADDRESS ZONING (o�t'ice use)
G
LEGAL DESCRiPTION (office use only)
LOT BLOCK ADDITION PID
OWNER-
(Name) 12.N�. �I�JV�''�t (Phone)
(Address) � �
BUII,DER /� ��
(Company Name) ��l � l.P��T��'� �A �. (Phone) C� l� 3d $ 3�S7 g
(Contact Name) �.�� (Phone)
(Address) ' �,
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Conne io
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III N 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 hereby certify that l have fumished information on this application which is to the best of my knuwledge rrue and correct. 1 also certify that 1 am the owner or authimzed agcnt for the
abuve-mennoned property a that all cunstruction will conform to all existing state and local laws and will proceed in aceordance with submitted plans. I am aware that the buiidmg
ufficial ca revoke t per or just cause Furthermare, I hereby agree that the ciry official or a designee may enter upon the properTy to perform necded mspections.
X � � 3 t �5 �-- �
Si re Contractor's License No. ce
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 Re t NO.
Date . L B .
Buildin � Ufticial Date
Th�s �s to certify that the request in the above applicanon and accompanying documents is in accordance with the Ciry Zoning Ordinance and may proceed as requcsted. This ducument
when signed by the City Planner consututes a temporary Certificare of Zoning compliance and allows construction to commence. Before occupancy, a Cert�ficate uf Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372