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oF PRl�� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
� �
'�Ip I. White File
2. Pink �,� PERMIT NO. I_���
3 Yellnw Applitflnl
Please or rint and si at bottom
ADDRESS �� ZONING (ott'ice use)
�3 2 z Z �, ��-,�,✓ � , ,
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER /
(Name) �i` �' S �I /. a.�v (Phone)
N�
(Address) 3 Z Z .-
BUII.,DER
(Company Name)_� �nf- r�� t �'v S � ,�s�� i �'► � (Phone) �S� " 1 1`�U "�� � � 7
(Contact Name) �,�'�� (Phone) �S�- �d� �'S.S�
(Address) � ,�-/� ��
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Co ection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Constiuction: I II III N V A B pROJECT COST/VALLTE $ �v �� � vv
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
1 hereby certif'y that [ have fumished �nformation on this application which is to the best of my knowlcdge tnie and correct. I also certify that I am the uwner ur authonzed agcnt for the
above-mennoned prope n all co ill conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildm�
official can revo for jus thermore, I hereby agree that the city official or a designee may enter upon the Property ro perform necded mspectiuns.
X ��b���
Signature Contractor's License No. Date
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 $ . 7�
This Application Becomes Your Building Permit When Approved Paid ReCei N.
Date B
Buildin � Utlicial Date
Th�s �s to certify that the rcqucst in the abuve applicat�on and accumpanying documents is in accordance with the Ciry Zoning Ordinantt and may proceed as requcsted. This ducument
when signed by the City Planner conshrotes a temporary Certificate of Zoning compliance and aAows construction ro commence. Before occupancy, a Cemficue uf Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9R50, fxx (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372