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o � PRtp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �,� �� / 7
� X AND UTILITY CONNECTION PERMIT �"'
U �
'yip �. Wh��e File pERMIT NO.
2. Pink City �� ` � � �
3 Yellow Applicam
Please e or rint and si at bottom
ADDRESS ZONING (oFlFice use�
�1 � 9 �' Q �.e ,(� v �- �� 1� �
LEGAL DESCRIPTION (off'ice use only)
LOT BLOCK ADDITION PID
OW1vER 2
(Name) k��`� � Ol.�� n L' ('I (Phone)
(Address)
(Company�Name) � � 1 C:�1 � vCT+ (Phone) ( ,� ��.- — Z ��- � � � � �
(Contact Name) � ��S � f� `'� (Phone) � I Z-'z-� Z Z° � v
(Address) lo �'� ti l f}i'�.p �C r"�,''` S�� � 7
TYPE OF W�RK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Con ctio
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Conshuction: 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 S
I hereby certify that 1 ve fumished information on this application which is to the best uf my knuwlcdge true and cocTect. I also certify that I am the i�wner or authonzcd agent for thc
above-mentioned prop rty and that all consnuction will conform to all existing state and loEal laws and will proceed in accordance with submitted plans. I am aware that the buildmg
official can revoke t s er i or just cause Furthermom, I hereby agree that the city official or a designee may enrer upon the property ro perform necded mspections.
X Za Sg fo 2�f � 2 t Z
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 $
r
This Application Becomes Your Building Pemut When Approved Paid � Recei NO.
Date � B
Buildim� Ufticial Date
This �s ro cr•rtify that the requcst in the above applicauon and accumpanying documents is in accordance with thc Ciry Zoning Ordinance and may proceeA as rcqucsted. This dixumcnt
when signed by the Ciry Planner consntutes a temporary Certificate of Zoning compliance and aAows construction to commence. Befure �xcupancy, a Ceruticate of Oceupancy 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