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o � rR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
U �
�r�NNe$��� i wn��e File pERMIT NO /
2. Pink City //... a ��(�
3 Yellow Applican� V
Please or rint and si at bottom
ADDRESS ZONING (ot�'ice use)
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LEGAL DESCRIPTION (o�'ice use only)
LOT BLOCK ADDITION PID
OWNER ¢ � � /�, �y
(Name) �Phone) 4l��� ` ��� "` / �S�
(Address) �5�� �i
BiJII,DER �, I a� 47aa � 9aD3
(Company Name) f (Phone)
(ContactName) (Phone) ��02'` 7�+�•^qc��; ? �
(Address) �3� �� �l1
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. � Misc.
Type of Cons�uction: I II III N V A B PROJECT COST/VALUE $/�p�,� �
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hcreby certity that I have fi�mished information un this application which is ro the best of my knuwledge true and correct. I also certify that 1 am the uwner or authunzcd agent for the
above•men oned property and that all constn�ction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
ufficial a revoke this permit r just e. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform necded msp • tions.
X ao�y� 8�f�
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 $ �
This Application Becomes Yoar Building Petmit When Approved Paid , Recei o. •
Date B
BuiWins Ufticial Dnte
This rs to certify that thc requcst in thr abuve applicanon and accompanying documents is in accordance with thc Ciry Zoning Ordinancc and may proceed u rcqucsted. Th�s document
when signrd by the City Planner consnmtes a tempurary Certificate uf Zoning compliance and allows construction to commence. Before occupancy, a Ceruticate 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 Priar Lake, MN 55372