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oF prt� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
U �
M �NNES�� P ' 2. I'iok �;� PERMIT NO.
_ 3 Yeliow Applicant /�� • � �
Please or rint and si at bottom
ADDRESS . ZONING (o�t'ue use)
lL� � � 3 ��e � % � � s�
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER f ,( n �
(Name) ! �)U�' � //�-U� (Phone) ��7� ' aa� �
(Address) 1 3 �/�(,e��+t' r � �
Bi.TII,DER J
(Company Name) C_ (Phone) �PS ��/a� y��
(Contact Name) l (Phone)
�Address) � � a v / �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roo6ng ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
_ ❑Addition DAlteration ❑Utility Connection � �[ - ���� �� ��
CODE: ❑I.R.C. ❑I.B.C. �Misc. � �a �'-�� �C )�a�k��..t"/u6J�
Type of Consrtruction: I II III IV V A B pROJECT COST/VALiTE $ 7� �U �'� 1
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have fumished information on this application which is ro the best of my knowledge tn�e and correct. I also certify that I am the owner or authorucd agent for the
abuve-mennoned property and that all consvuction' will conform to all existing state and local laws and will proceed in accordance with submitted plans. 1 am aware that the building
official can revoke this permit r just cause Furthe more, I hereby agree that the city of1'icial r a designee may enter u on the property to perform necded mspcctions.
X ��i�o ���i'� ���J� �y� �/ � �a -l�
� Signature Contractor's License Na 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 Pennit Whrn Approved P1id R i t No.
Date �. iZ..-
Buildin Utticiai Date
Th�s is to certify that the request in the above applicahon and accompanying documents is in accordance with the Ciry Zoning Ordinance and may proceed as requcstcd. This dixumrnt
when signed by the City Planner consututes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (9S2) 447-9850, tax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372