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o � rR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ��
� � AND UTILITY CONNECTION PERMIT � Z.' ?,._..
'I�jNNEg�qe' �. wh,�e File pERMIT NO. �
2. Pink City
3 Yellow Applicant '
Please or rint and si at bottom)
ADDRESS ���'� � � t�' � �,'� ( . • ZOIVING (ott'ice use>
� ,�,� c-� �� 3�,.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
� � � �'' (Phone) ��o�"�Q���� D�� .J �
�-
(Address)
BUII.,DER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Con tio
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B pROJECT COST/VALUE $
Occupancy Group: A B E F H I M R S U
Division: 1 2 3 4 5 (excluding land)
I hereby crrtify that 1 have fumished information on this application which is to the brst uf my knowledge uve and correcc I also certify that I am the owner ur authonzed agent for the
abuve-mennoned property and that all cunstruction will conform to ali existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
official can revuke this permit f just cause Furthermare, I hereby agree that the c�ty official or a designee may enter upon the property to perform needed mspectiuns.
x l��ffl� �',�- � 1 �
��' 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 Permit When Approved Paid ' Re t No.
Date W L
Buiidins Utlicial Date
Th�s �s to certify that thc requcst in the above applicanon and accompanying documents is in accordance with thc Ciry Zoning Ordinance and may proceed as requcstcd. This document
when signrd by the City Pianner consututes a temparary Certificate of Zoning compliance and allows construction ro commence. Before occupancy, a Ccit�ficate of Occupancy 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