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oF PR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT 7 Z�_ /Z�
�
~�NN6S0�� t. White File
?. Pink CpP PERMIT NO. / C��
3 Yellow A litant �
Please or rint and si at bottom
ADDRESS ZONING (ott'ice use�
���v1��tN �17�A1�.. ��._
LEGAL DESCRII'TION (ofl�ice use only)
LOT BLOCK ADDITION PID
OWNER
(Name) ,� � 1`1 C- � L L � (Phone)
(Address)
B�3Ii.DER � l LL. �� R�1 Jv FC:.Z.�� % S� G�7� 7 Z Z-�
(Company Name) (Phone)
(Contact Name) {�H-1 L�_ �� RL�NF�- (Phone)
(Address) 01�'� �( �.�-H-L.f�/V � UlC ITvL �CJ2/JS U! �-� �'1'1/l� �>..7v�
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition �Aiteradon ❑Udlity Conne tion
CODE: ❑I.R.C. [�I.B.C. ❑ Misc.
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 Z 3 4 5
I hereby certify at v s i at ' which is to the best of my knowicdge rrue and correct ( aiso certify that I am the owner or authorued agent for the
abovamenti ed at n. ue n' conform t�o a 1`�Z�stip�state and local laws and will proceed in accurdance with submitted plans. I am awam that the buildmg
ufficial e far � c F th n�e, 1 hereby agree that the c�ty official or a designee may enter upon the property to pertorm needed mspertions.
X NIA� o �?3�LL.� 2_.
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 $
Penaity $ SewerJWater Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Bui3der's Deposit S
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DLJE $
This Applicadon Becomes Your Building Pemtit When Approved Paid � ReCei t
Date B
Buildin � �tTiciai Dnte
This is to certify that thr requcst in the above appticatinn and accompanying documents is in accordance with the City Zoning Ordinance and may proceed ac requcsted. 7'his dixument
whrn signed by the Ciry Flanner consatutes a tempa� Certificate of Zoning compliance and alluws construction to commence. Before c�ccupancy, a Certdicate uf Occupancy musc be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9RS0, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372