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�� PRI ��P CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� D� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" � AND UTILITY CONNECTION PERMIT
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r NNES��
I. White File pERMIT NO .
2, Pink City /� s � 7� �
3. Yellow Applicant ��
lease e or rint and si at bottom
ADDRESS ZONING (oteice use)
� V . S�
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) � �tN�A 7A2�tc (Phon�ea �� — � 3 S�
(Address) �$�/� �qK VC S� � � ' �. .�rF' /!! , 3
BUII..DER
(Company Name)��/�p��sN S7'.tuLTZOJ�I "�iuG. . (Phone) 9�2` 4�� ^4y�i�0
(Contact Name) ..�G�*` � �y � � .� --- (Phone) Crl�- � � 5 � S
(Address) / p G t�l,) _ '� 3 — 3 N S
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �2e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connlction
CODE: �I.R.C. �I.B.C. ❑ Misc:
T e of Construction: I II III N V A B .
Occupancy Group: A B E F H I M R S U PROJECT COST/VALi1E S �� S°�' �"`
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information on this application which is ro the best of my lmowledge true and correct. I also certify that I am the owner or authorized agent for the
above-mentioned property and that all rnnstruction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am awaze that the building
official can rev e this permit for just se. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X a�- Q 3 7 a 7 � �-��--� �
Si tur 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 8c Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $
This Application Becomes Your Building Permit When Approved Paid Recei N
Date J`Y' B `
Buildin O�cial Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the Ciry Planner constiwtes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning D'vector Date Special Conditions, if any
24 hour ootice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Mionesota 55372
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