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oF eR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
.. � AND UTILITY CONNECTION PERMIT �- L3 _<L�
U �r
��NNES��� i; � ��i c�y PERMIT NO . / Zi -�
3 Yellow Applicao�
Please or rint and si at bottom
ADDRESS ZONING (ot�'ice usc�
I � S'7 � �'2��u.� ��c..._ S��
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNE �� CC�
(Name) C " �� (Phone)
(Address)
BIJILDER � ( �C. ( � R�7/� ��Z.DT � �S � � 7O [ Z Z j
(Company Name) , (Phone)
(Contact Name) � L�-� � ���� F�-� � (Phone)
(Address} Q(� �` G �{��� (J! �1-c) l�}'t�t T11�$�U/ L� !�� ���
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition �Alteration ❑Utility Conne i n
CODE: ❑I.R.C. �I.B.C. ❑ Misc.
Type of Consmiction: I II III N V A B pROJECT COST/ VALUE S
Occupancy Group: A B E F H I M R S U
(excluding land)
Division: 1 Z 3 4 5
I h��reby certify that a d form on this ap ' t which is to the brst of my knowlcdge true and correct. I alsu cettify thar 1 am the owncr or author�zcd agent for thc
atwve-mentione ro all co wil nf �"°"� and locai laws and will proceed in accordance with submittcd pians. I am aware that thc buiidmg
ufficia! can r i just cai h by agree that the city offia or nermay enrer upon the propetty to perform nrcdcd inspcMions.
X �vl�' c� L ! Z
S gnature 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 # $
Piumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Buiider's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DLTE $
Tiuis Application Becomes Your Building Pemtit Whm Approved Paid Re t NO.
Date B
L3uildina Utiicial Dnte
Th�s �s to certify that thc requrst in the above appiicat�on and accumpanying documenu is in accordance with the City 7.�min� Ordinance an ay proceed u requcsted. Th�s documcnt
when signed by th� Ciry Planner ci>nshtutes a temporary Certificate of Zoning compliance and attG�ws construction ro commence. Before ixcupancy, a Cerhficau of Occupancy must be
issucd.
Ylanning Dir�tor Date Special Conditions, if any
24 hour notice for all inspections (952) 447-98511, faz (952) 407-4245
4646 Dakota Street Prior Lake, MN 55372