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oF PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
U �r
M��'NES��P 1 White File
2. Pink �,� PERMIT NO. ��Z Z¢�
3 Yellow Applicant
Please e or rint and si at bottom)
ADDRESS ZONING (otfice use)
1 `-� la � ��'l.e ,��J r��,
LEGAL DESCRIPTION (oflfice use only)
LOT BLOCK ADDITION PID
OWNER /� (�
(Name) �Q.l7}28D �- �� ;�'�f,�1f� 11f�V�n( (Phone) /J�� ' �d7 • :7�7�
(Address) � {� /�'j,� L �J��v 7
BITII.,DER /� � ��� �� /� L�� - 7� y� o �(,p
(Company Name) `�C'.1��'r �P/yJOG(X.l.l1ZQ �7 L (Phone)
(Contact Name) (Phone)
(Address) � � G � J�U/ �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing e-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III N V A B pROJECT COST/VALL7E $ Id , 7�07 -�
Occupancy Group: A B E F H I M R S U
Division: 1 2 3 4 5 (excluding land)
I hcreby certify that I have fiirnished information on this application which is to the best of my knowledge tnie and correct. I also certify that I am the owner or authorizcd agent for the
above-menuoned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke this permit for ist cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform necded mspections.
x ��� ���mC� ��Q O/ 7y� �3 " �e-1�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 $
This Application Becomes Your Building Pernut When Approved Paid � R ei t NO. ,�
Date
Buildin� Otticial Date
This �s to certify that the request in the above application and accompanying documents is in accordance with the Ciry Zoning Ordinance and may proceed as requcstcd. This documenc
when signed by the Ciry Planner consntutes a temporary Certificate of Zoning compliance and allows construction ro commence. Before occupancy, a Certificare of Occupancy must be
issued
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (9S2) 447-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372