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oF rRt CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
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~�n'NES��� i. wn��e File pERMIT NO . ' �—(}���'1
2. Pink City
3 Yellow Applicant ZS
Please or rint and si at bottom
ADDRESS ZONING (ott use)
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LEGAL DESCRIPTION (oElfice use only)
LOT BLOCK ADDITION PID
OWNER "
(Name) C (Phone)
(Address)
BUII,DER q / ' D
(Company Name) (Phone) / 5d ' c��(7 � �/� �
(Contact Name) (Phone)
(Address) ` � �
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 Constiuction: 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 ce ' that I ave (iimished mformat' n this application which is to the best uf my knowlydge true and coRect. I also certify that I am the owner or authonzed agent for the
abuve-m ioned •rry and that ll cu u on will co form to ail existing stare and local laws and will proceed in accordance with submincd plans. I am aware that thc buildmg
official an r e this per ' st ca urthermore her y agree that the c�ry official or a designee may enter upon the property to perform needed mspections.
X , ���� 9 a-��
Signature Contractor's License No. Date
Permit Valuation S G Park Support Fee # $
Permit Fee $ � t,� 7 SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ s 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 $ �''7q
This Application Becomes Your Building Permit When Approved Paid ��k Recei t NO.
/�� � � `� — I f Date - - � B /1-<
Buiidim� Ufticial Date
Thu is to certify that thc rcqucst in the abuve applicanon and accompanying documents is in accordance with thc Ciry 7A�ning Ordinance and may proceeA as rcqu��ted. This dixument
when signed by the City Planner consumtes a temporary Certi6cate uf Zoning compliance and allows consrruction to commence. Before occupancy, a Cenificate �>f Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372