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� � CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
D� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �/
" AND UTILITY CONNECTION PERMIT ��� `1_ <�Z--.
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l NNEs°�
1. White File pERMIT NO .
2. Pink City / � . S � �
. 3. Yellow Applicant �
lease e or rint and si at bottom)
�D�$$ g6� - 3�S6 ° `j PJ � G Z�NING (office use)
LEGAL DESCRiPTION (of�'ice use only)
LOT BLOCK ADDTTION PID
�WNER n e�c.� ��e3t /�SSDc•�{�o^ (Phone) 952
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(Address)
BUII.,DER
(Company Name) � �� E ��/�P� .� .�^� . (Phone) ?6 �— 20 2 -63y6
(Contact Name) cl v3��-� S^ ��� (Phone) 763 - 2 a 2 - 63�f�
(Address) � 3�� �..o��� r ' �.,�ct�(� 6
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addirion �Alteration ❑Utility Conn on
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc:
Type of Constructioa: I II III IV V A B 2 S 7Y6. ��o
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 fumished information on this application which is to the best of my ]mowledge true and correct. I also ceitify that I am the owner or authorized agent for the
above-mentioned perty and that all wnstruction will conform to all existing state and local laws and will proceed in accardance with submitted plans. I am awaze that the building
official can revok is permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x �' � B� 3 2 3 S�f� S'-3v -IZ
Signature Contractor's License No. Date
Permit Val tion 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 $
Tlus Application Becomes Your Building Permit When Approved Paid Recei o.
Date B
Buildin Official Date
This is to certify that the request in the above applicarion and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as mquested. This document
when signed by the City Planner consHtutes a temporary Cerlificate of Zoning rnmpliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Duector Date Special Condiuons, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-0245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372