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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� D� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" AND UTILITY CONNECTION PERMIT � � - Z� - � �
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1. White File r
2. p�� �� PERMIT NO. `,, �`-I ��
3. Yellow Applicant
lease e or ' t and si at bottom
ADDRESS� ��-(/ v �� � r ZONING (oteice use)
��� ��
LEGAL DESCRIPTION (oflf'ice use only)
LOT BLOCK ADDITION PID
�� ER � CFG� es � ��`7� l �-°�� v � �� (Phone) �j��%� ��
(Address) � �� Cd� �G�
BUII.DER �� � N�c = l�.1/� !v �. (p ) ��� � " ° ^ - 7 �(
(Company Name) hone
(ContactName) C-�.�M (Phone) ������ r ��
(Address) CO� �j dl�a✓,5 � , �G� ' f'� �
TYPE OF WORK ❑ New ConstrucHon ❑Deck QPorch ❑Re-Roofing Re-Siding �Lower Level Finish ❑ Fireplace
❑Addidon ❑Alteration ❑Utility Connection
CODE: �I.R.C. �I.B.C. � Misc:
T�pe of Construcrion: I II III IV V A B j� f�DO j
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE S��7
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have fiunished informaCOn on this applicadon whlch is to the best of my knowledge true and corred. I also certif'y that I am the owner or authorized agent for the
above-mentioned mperty and that all constru ' will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am awaze that the buildiug
official can this permit for just caus ermore, I hereby agree that the aty official or a designee may enter upon the property to perfotm needed inspections.
x ��� ? ��_`7 �-- 3--��
e Contractor's License No. Date
Permit Valuation ��'�� Park Support Fee # $
Permit Fee $ � �� -� .� SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ v -� 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 $'� c� �'
,.
Applicallon Becom Your Building Permit When Approved Paid ReCei t No. U
y � s�� �����_t l Date C — ,� — 11 B
Buildin Official Date
This is to cerdfy that the request in the above applicaaon and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
whea signed by the City Planner constitutes a temporary Certificace of Zoning compliance and allows construction to commence. Before occupancy, a CerdHcate of Occupancy must be
issued.
Plaming Director Dato Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fea (952) 447-4245
4646 Dakota Street S.E., Prior I.ake, Mianesota 55372