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oF PRJp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
� �
♦j L White File pERMIT NO. �L _ J1��
2. Pink City
3 Yellow Applicant
Please e or rint and si at bottom)
ADDRESS ZOIVING (office use)
����� � .,!- � i ' � '
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
�WNER ���—�� f - f ( � �" (Phone) f�/o - �''-�(: - /� /
�
7� `
(Address) � r ✓1���
BUII,DER / � � / �
(CompanyName)�iryc,h/�1�it.1' .�� 1`�-��';Y� (Phone) l2'�� ���
(Contact Name) �.�in� -� � `� (Phone) ��� /. ��`t' — !�9' ��
(Address) � s�J1/Q
TYPE OF WORI� ❑ New Const►uction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Ucility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Constxuction: I II III IV V A B PROJECT COST/VALLTE $���..�_
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that 1 have fumished information on this application which is to the best of my knuwlcdge tnie and correct. 1 also certify that I am the owncr ur author�zed agent for the
above•mentioned property and that Il construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. [ am aware that the buildmg
official can revoke this er ' for st ca Furtheyn , I hereby agree that the ciry official or a designee may enter upon the property to prrform necded mspections.
I X ;� `� ��3 �'�fs��- �'
ignature Contractor's License No. D te
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 DLTE $ , 7�
This Appiicadon Becomes Your Building Permit Whrn ApQroved Paid Recei .3
Date B
Buildim� Utlicial Date
Tfi�s �s to certify that the requcst in thr above applicanon and accumpanying documents is in accordance with tfie Ciry Zoning Ordinance and may proceed as requ��ted. This ducument
when signed by the City Planner consututes a rempurary Certificate of Zoning compliance and allows mnstruction to commence. Before uccupancy, a Ceruficue uf Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour notice for afl inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372