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o � PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
.". x AND UTILITY CONNECTION PERMIT
U �
��A'NES��� I. White File �
z �;�, � PERMIT NO. ,
3 Yellow Applicant
Please or rint and si at bottom)
ADDRESS ZONING (of�ce use)
� � �- � r� -St�re
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
owivER -T' �-I �-17- 318?s
(Name) �J ��s ���C� _ (Phone) �.�a�"
(Address) rj � C fa� � �trt �
BUII,DER
(Company Name) (Phone)
(Contact Name) neVirl Q�.r1 (Phone) ,�l o� �77�` �l y
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing �2e-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utiliry Connection
CODE: R.C. ❑I.B.C. ❑ Misc.
Type of ons�truction: I II III N 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 5
I hereby certify that 1 have fumished information on this application which is W the brst of my knowledge true and correct. 1 also certify that [ am the uwner or author�zed agent for the
ab enuoned pro • and th struction will conform ro all existing state and local laws and will proceed in accordance with submitted pinns. I am aware that the buildmg
�cial n revoke t s per it for�u s. Furth re, I hereby agree that the c�ry official or a designee may enter upon the property to perform necded mspections.
X
' ature Contractor's License No. Date
P it Valuation •� Park Support Fee # $
v
Permit Fee $ � �— SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ � Pressure Reducer $
�
Penalty $ Sewer/Water Connection Fee # $
Piumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $� f ?'S
This lica ' n c me our Building Permit Wh Appr ed Paid ReCei t NO
Date B
S�
Buildina Utticia ate
Th�s u to certify that the requcst in the abuve applicat�on and accompanying documents is in accordance with the Ciry Zoning Ordinantt and may proceed as requcsted. This document
when signed by the City Planner consntutes a tempurary Certificate of Zoning compliance and allows construction tu commence. Before uccupancy, a Ccitrticate of Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372