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o � pRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
�, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE � LS �/
� � AND UTILITY CONNECTION PERMIT d r �
U �rj
�IIj �. Wh;,e File pERMIT NO.
2. Pink City
3 Yellow Applicant
Please or 'nt and si at bottom
�Dj�$. g ZOI�TING (office use)
/5�0! aw a L��� f�tD
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER t ��
; �tame) /�3t ��b- � O �/9.S (Phone) �9�" /.S -
(Address) /�Z� j qp� L�et/�. /V
BUII,DER /�
(Company Name) ��lsll�Isf� l.��s�s1]�Nc77 uL.J (Phone) qf �'
(Contact Name) ��� (Phone)
(Adciress) � 2 0 ��`RN�F 4£ .�I�e�L. ,..Sa�11�•+ cf'��Z
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition �Alteration ❑Urility Conn �
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: 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 h�7eby certify that [ have (vmished infi�rmation on [his appiication which is to the brsr of my knowlcdge true and correce ! also certify that 1 am the uwner or author�zed agcnt for the
above-mennoned properry and that all cunstruction wiU conform to all exisnng state and local laws and will proceed in accordance with submittcd plans. I am aware that thc buildmg
official can revoke this pe ust • urthermore,l hereby agree that the ciry official or a designee may enter upon the property to perform necded mspections.
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2ey �-- '�^'�S^2el/
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 $
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This Application Becomes Your Building Perntit When Approved Paid ei t No.
Date
.
BuilJin � Utlicial Date
Thu u to certify that the requcst in the abuve applicat�on and aceompanying documents is in accordance with the City Zoning Ordinance and may proceed as requcsted. Th�s document
when signed by the Ciry Planner consntutes a temporary Certificate of Zoning compliance and allows construction tu commence. Before uccupancy, a Ccit�ficam uf Occupanty must be
issucd.
Pla►ming 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