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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 �- �� l/
U �
A/jNNE$�qP I. Whi�e File
z �;�, � PERMIT NO. �Z
3 Yellow Applicant
E1 r rint and si at bottom)
ADDRESS ZONING (oflFice use)
� 2 � 0 �,j r/c�(�� r— �i�-lL
LEGAL DESCRiPTION (office use only)
LOT BLOCK ADDITION PID
ame �tiC�t�1/l�'J �X.. (.tA'1 (Phone) —/� 2 ' �'gy' S � � �—
(Address) �V� � � C�w 1�C?� cL� Cj� • �G�,f/{. / ►' / � SS � !7
BUII. � � � .-�-r'c/Gd� � Pho �v � Z "Z � S —1 �
ompany Name ��^
ntact a ) ^ (Phone)
ress U� `� �� ���L�SS�✓1 �� O — ��a� � 23
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Con ction
CODE: ❑I.R.C. ❑I.B.C. � Misc.
Type of Construction: I II III N V A B pROJECT COST/VALUE S
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5 •
I hereby t I have fumished information on this application which is to the best of my knowtcdge tnie and correct. I also certify that 1 am the uwner or authonzed agent for thc
above- enn pe nd tha[ all cunstruction will conform to all existing stare and local laws and will proceed in accordance with submitted plans. 1 am awarc that the buildmg
uffici can v h' r it for just cause. Furthermore, I hereby agree that the ciry offici� a esi nee may�ter upon the property to perform necded �stipc�� �
X
i ntractor's License Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
Penaity $ 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 DLJE $
This Application Becomes Your Building Permit When Approved Paid • ei t NO.
Date
Buildina Ufticiai Date
Th�s �s to certify that the requcst in the abuve applicanon and accompanying documents is in accordance with thc Ciry Zoning Ordinance and may pnxeed as requcsted. Th�s document
when signed by the City Planner constnutes a temporary Certificate of Zonmg compliance and alluws construction to commence. Before uccupancy a Certificam uf Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9R50, fax (9S2) 447-4245
4646 Dakota Street Prior Lake,1VIN 55372