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o � PR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
F ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �� 9 //
.. x AND UTILITY CONNECTION PERMIT
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4� �. whice File
Z �;�� � PERMIT NO. `
3 Yellow Applicant /
Please or rint and si at bottom
ADDRESS ZONING (oFlFice use)
a,
x
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LEGAL DESCRiPTION (office use onty)
LOT BLOCK ADDITION PID
(��e R 1 �� (Phone) �S� ' ��� — J1 CTG-�
(Address) �'.N'�, �-5
BUII,DER
(Company Name) � (Phone) ��� �
(Contact Name) (Phone)
(Address) � � � �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �Ze-Roofing �te-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connecnon
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B pROJECT COST/VALiTE S
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hc7eby certify th I have fumished mformation on this application which is to the best of my knowlcdge true and correct. 1 also ceRify that I am the owner or author�zed agent for the
above-menuone operty and that all cunstn�ction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buiidmg
�X �cial can r e is r' r just cau urthermore, 1 reby agree that the ciry officia a desi�e�nrer u� t e pr etTy to perform necded mspections. —
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-- Signatur 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 $ SewerlWater 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 $
This Application Becomes Your Building Permit When Approved Paid R i t No.
Date i
Buildina Ufficial Dnte
This u to certify that the requcst in the abuve applicatwn and accompanying documents is in accordance with the Ciry Ziming Ordinance and may proceed u requcsted. Th�s document
when signed by the City Planner consnmtes a tempurary Certificate of Zoning compliance and allows construction tu commence. Before �xcupancy, a CeR�ficate 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