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�� PRI�fP CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� D� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT 1� - l�
d ,�e�
�'NES�
l. White File pERMIT NO . ' I � I' ��
2. Pink Ciry
3. Yellow Applicant
lease e or rint and si ai bottom
ADDRESS ZONING (office use)
9/� G R o 5 5 �Z � s�. �/ �
LEGAL DESCRIPTION (oflflce use only)
LOT BLOCK ADDITION PID
OWNER / /
(Name) _�'7 � /2� �` �' 7"E (Phone) �J�� �a�0 '" J�9��.
(Address) G�ZO 5 T. •• ' rn- S
BUII,DER
(Company Name) �^ �� �!�ST2[.�7�"oN �/v�- (Phone) Q�
(Contact Name) (Phone) C ' � /a �.3 gCo• � S h�
(Address) /(q� �, , 4 . S 76 .� - 3 � /'1'! 1� S S 3� g
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �Re-� g ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
�Addition ❑Alteration �Utility Connection
CODE: ❑I.R.C. ❑I.B.C. � ❑ Misc:
Type of Construction: I II III IV V A B �� � � 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 lmowledge true and coaect. I also certify that I am the owner or authorized agent for the
above-mentioned property and that all construMion will conform to all existing state and local laws and will proceed in acrnrdance with submitted plans. I am aware that the building
official c revoke this permit for just cause Furthermore, I hereby agree that the ciry official or a designee may enter upon the property to pedorm needed inspections.
x ��(� 37�7/ /�
Signa Contractor's License No. Date
Permit Valuation `�S �-v Park Support Fee # $
Permit Fee $ � GI 7s' SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ S" 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 S 7�
Tlvs Application Becomes Your Building Permit When Approved Paid �-�t� Recei t NO.
Date / — �� B
10 �.�- /i
Buildin Official Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requesced. This document
when signed by the City Planner rnnsdtutes a temporary Certificate of Zoning compliance and allows conswction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Miooesota 55372