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� �;,, ,�� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� j `,, ',, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE � � � � �
"`�.%���' �� �' AND UTILITY CONNECTION PERMIT
� , ` �e-
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]. White File pERMIT NO . ���(((
2. Pink City �� � �g �
� 3. Yellow Applicant
(Please or rint and si n at bottom)
ADDRESS ZONING (ott'ice use)
5�q�- eGr�� na I R-�c� e Tra►1 SG ,�r; �r L�I�e, l� N
LEGAL DESCRIPTION (office use only)
LOT �-- BLOCK � ADDITION `p�f �Y�p�� Q-; (� � s � Pt PID �j GjO� � 22C�
(N � (Phone) � � 'y�'� - �"JZ �J �
(Address) �2 ��� , p•�-pJ 2 1`` � C vS3
BUII,DER
(Company Name) (Phone)
(Contact Name) �C� � R C,�� (Phone) � �OJ ' 2 � � ' � 22
(Address) ���-�j g ( p, � (' �
TYPE OF WOItK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding �Lower Level Finish ❑ Fireplace
DAddition �Alteration �UtIlity Connection
CODE: �I.R.C. �I.B.C. ❑ Misc:
Type of Constnution: I II III IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correM. I also cer6fy that I am the owner or authorized agent for the
above-mentioned property and that a!1 construction will conform to all existing state and loca! laws and will proceed in accordance with submitted plans. I am aware that the building
otPicial can revoke this permit for just cause. Furthermore, I hereby agree that the city oflicial or a designee may enter upon the property to perform needed inspections.
X �� l��.P������� s-e-��
ature Contractor's License No, Date
Permit Valuation Park Support Fee # $
Permit Fee $ "�. C 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 $
Tlus Application $ecomes Your Building Permit When Approved Paid el t NO.
Date �
Bui(din Official Date
This is to certify that the request in the above appHcadon and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
, Planning D'vector Date Special Conditions, if auy
24 hour notice ior all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372