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o � PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE /'
x AND UTILITY CONNECTION PERMIT V �' I I
U �
a �. wn��e File PERMIT NO . I
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3 Yellow Applicam
Please or rint and si at bottom)
ADDRESS ZONING (oFlr'ice use)
! �, � �1 '�. �- �'� � S � h � ' �
LEGAL DESCRiPTION (of[ice use only)
LOT BLOCK ADDITION PID
OWNER 5 s 3-
(Name) Cj �� N� N\ �' i� L i. �*1 (Phone) � 41 - �� G �I 1
(Address) �( ( 1�- C. V1 �C S� 17 r L- l R S' -
BUII.,DER
(Company Name) � �` �- �` (Phone) ") S �- 4 4-1 ..`a-e_ GT�
(Contact Name) (Phone)
(Address) S W .�v� L�
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �te-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteradon ❑Udliry Connecnon
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III N V A B pROJECT COST/VALLTE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
1 hereby certify that I have fi�mished information on this application which is to the brst of my knowledge tnie and correct. 1 also certify that I am the uwner or authonzed agent for the
abuvc-menuonrd property and that all constnittion will conform to all existing state and local laws and will proceed in accordance with submittcd plans. [ am aware that thc buildmg
official can revoke this permit for just cause Furthermore, I hereby agree that the c�ty official or a designee may enter upon the properry to perform needed inspecuons.
X
Signature Contractor's License No. Date
Permit Valuation S U G 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 DiJE $
This Application Becomes Your Building Permit When Approved Paid 1� � Recei t NO. /
!� ��� j � ` ( ( Date - I B
Buildin � Ufticial Date
Th�s �s to certify that thc requcst in the abuve applicauon and accompanying documents is in accordance with the Ciry Zoning Ordinance and may proceed as requcsted. This dixument
when signed by the City Planner constrtutcs a rempurary Certificate uf Zoning compliance and allows conmuction ro commence. Befure uccupancy, a Ccrtificate of Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372