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oF rtt� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
.". � AND UTILITY CONNECTION PERMIT
U �r
'VjA, � wnae File pERMIT NO
2. Pink City / /� O � ��
3 Yellow Applicant ��
Please or rint and si at bottom)
ADDRESS ZONING (otfice use)
S/�{� G-r��l D� 7�'L.�- .
LEGAL DESCRIPTION (oflf'ice use only)
LOT BLOCK ADDITION PID
OWNER � � S � �
(Name) (Phone)
(Address) ���
Company�Name) div — 7�r��r� (�,�5% . (Phone) C1 � Z-- �l�'Z 3 J ts�
(Contact Name) �u�7>^� (Phone) �� 2- S 7 ��o
(Address) 7 3 Z .S ' S k� L 1? �✓�.
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Udliry Connection
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
I hereby certify th 1 have fumished information an this application which is tu the best of my knowlcdge true and correct. I aiso certify that [ am the owner or author�zcd agent for the
above-menno p perty that a c�,nstru on will conform to all existmg state and local laws and will proceed in accordance with submittcd ptans. 1 am aware that the buildmg
I official can r ok his pe K c .jjlpreby agree that the ciry official ur a designee may enter upon the property to perform necdcd ins •cno s.
X ?�(a 3 S Z3 c> � G/i
Si a Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Pian 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 DUE $ 9
This Appiication Becomes Yoar Building Permit When Approved Paid ReCel t NO
Date B
BuilJim� Ut7icial Dnte
Th�s �s to certify that the rcqucst in the abuve applicanon and accompanying documents is in accordance with the Ciry Zoning Ordinance and may proceed as requested. Th�s document
when signed by the City Planner consnrotes a remporary Certificate of Zonmg compliance and allows construction to commence. Befure �xcupancy, a Certfficam 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 Prior Lake, MN 55372