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o � rR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
y ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 1D ./�` //
x AND UTILITY CONNECTION PERMIT F C
U �
'djN L Whire File pERMIT NO. /`
2. Pink City ! �
3 Yellow Applicam /
Please oc rint and si at bottom
ADDRESS ZONING (of�'ice use)
��`�8 � I S3io J�{f«� /'.�;�
r, n� �al.� S"5372
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
BUII.,DER
(Company Name) � �^ � �� �"` t - (Phone) �6 3 - 2 0 2 - 6 3 Y6
(Contact Name) s r. ��,.. , t�. (Phone)
(Address) ,�� r'�c P .a, �,�c o �'N S�S362
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Conne ion
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III N 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 I have fumished infnrmation on this application which is to the best uf my knowlcdge true and correct. I aiso certify that ! am the owner or authonud agent for the
above-mennoned property and that all construction will conform to all existing stare and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
official can revok is prrmit for just cause. Furthermore, I hereby agree that the c�ty official or a designee may enter upon the property ro perform necded mspectiuns.
x �- �.03 23.5�� �p-/y-!/
Signamre Contractor's License No. Date
Permit Va ation 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 Pemtit Whrn Approved P11d eCei t No.
Date
BuilJinc Ut7icial Date
Thu u ro certify that the requcst in the abuve applicatwn and accompanying documents is in accordance with the City Zoning Ordinance and may proceeA as requcsted. Th1s dixument
when signed by the City Planner consntutes a tempurary Certificate of Zoning compliance and allows construction to commence. Befure occupancy a Certificate uf Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372