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D
oF PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �j� �S �`/
.. x AND UTILITY CONNECTION PERMIT �
U �
��HHeso�° z � ���` c� Y PERMIT NO . l !/
1 Yellow Applican� �
Please or rint and si at bottom)
ADDRESS � � � ' � ,J/ w /�� � , �
ZONING (office usc)
�"I �� C
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
�WrTER /�/� � V/ �/ ' 'e � (Phone) ���/ v� ��_
/ �� �
(Address)
$iJII,DER � rC (} �/ S (��c+� � ��lJ� � � ` �
(Company Name
(Contact Name) Cl � (Phone)
(Address)
� (, �( ✓— ! C � -(
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition �Alteration ❑Utility Conn
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B pROJECT COST/VALUE $
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 I have fiimished �nformation un this application which is w the best of my knuwlcdge true and correct. I also certify that I am the owner or authuriud agent for the
above-mennoned property and tha all cunsreuction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
official can revoke this permit fo se. Furthermore, I hereby agree that the city ot�'icial or a designee may enter upon th property to perform necded ms cetions.
X ZooqoY��
Si re Contractor's License No. ate
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 DiJE $ ,S�
.
This Application Becomes Your Building Pernut When Approved Paid � ei t NO.
Date d�
BuilJins Ut7icial D�te
This �s to certify that the request in the above applicanon and accompanying documents is in accordance with the Ciry Zoning Ordinantt and may proceed as requcsted. Th�s document
when signed by the Ciry Planner consntures a temporary Certificate of Zoning compliance and allows construction to commence. Befure �xcupancy, a Ccrt�ficate of Occupancy must be
issucd.
Planning Airector Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9850, f�x (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372