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o � PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 9� ��
AND UTILITY CONNECTION PERMIT
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'aIj I. White File
Z �;�, � PERMIT NO. a �� �
3 Yellow Applicam
P e or rint and si at bottom
ADDRESS f��n� �( ' �� ZONING (otlFice use)
� O�
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER I (� pQ
(Name) ��'�2C K.t_ (Phone) _ ��"��� 1
(Address)
B � ' (�/� �`�O
Company Na C (Phone)
ontact Name � e)
ress � v�j rct � k 4� � Or � N�
TYPE OF WORK � New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Con ectio
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Constiuction: I II III IV 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 certi that t have fumished mformation un this application which is ro the best of my knuwledge tnie and correct I also certify that I am the owncr or author�zcd agent for thc
above-menn ed property and that all cunstruction will conform ro all existing state and local laws and will proceed in accordance with submitted plans. I am awaze that the buildmg
ufficial can r oke this rm' o just cau urthermore, I hereby agree that the city official or a designee may enter upon the property to perform necded mspecuu
X ^� � l/
Signature Contractor's License �{ Dare
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 Firepiace Permit Fee $ TOTAL DUE $ �
This Application Becomes Your Building Permit When Approved Paid S R el t NO.
Date � I B •
Buildina Utfiicial Date
Th�s �s to certify that the requcst in the above applicahon and accompanying documents is in accordance with thc City Zoning Ordinance and may proceeA as requcsted. Th�s ducument
when signrd by the Ciry Planner consntutes a temparary Cenificate uf Zoning compliance and allows construction to commence. Before occupancy, a CertiFcuc uf Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for AII inspections (9S2) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372