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oF PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� �
AND UTILITY CONNECTION PERMIT �.� Z-- I Z—
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b�NNe$o�� I. White File
2 �;�� � PERMIT NO. �
� 3 Yellow Applicam �
Please or rint and si at bottom
ADDRESS ZONING (ot�'ice use)
! 7 2 8' � o�, s f� v� s�. �r� �r �, �
LEGAL DESCRIPTION (oflfice use only)
LOT BLOCK ADDITION PID
OWNER � J I '/ � �
(Name) �/ � � ` �-t l� V�S Vl-; in (Phone)
(Address)
BUII,DER _., .,
(Company Name) � t�n--eiS (�- c-- (Phone) 6 �� — k 6 �` ` � 9 ? S�
(Contact Name) � (Phone)
(Address) ��(,� 7 8d , l�✓
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Ucility Connection
CODE: ❑I.R.C. ❑I.B.C. �""" 1 � �
Type of Construction: I II III IV V A B pROJECT COST/VALUE S
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
1 hereby certify that ( have fu shed informatio on this application which is ro the best of my knuwlcdge true and correct. I also certify that 1 am the owner or authonzed agent for the
above-menUOned property a that all cunstri ion wip conform to ail existing state and local laws and wiil proceed in accordance witi� submitted plans. S am aware that the buildmg
uff'icial can revoke t ere;-��hereby agree that the dry official or a designee may enter upon the property to perform necded inspect �ns.
x Gt '2-c�6 3� 7S p 2 (Z
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 $ „
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This Applicarion Becomes Your Building Permit Whrn Approved Paid . ei t NO.
Date
Buildin � Utlicial Date
This is ro certify that the requcst in the abuve applicauon and accompanying documents is in accordance with the Ciry Zoning Ordinance and may procreA as requcsted. This diicument
when signed by the City Planner consumtes a tempurary Certificate of Zonmg compliance and aAuws construction to commence. Befure uccupancy a Cernficate uf Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372