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�� �' � CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec d
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" �' AND UTILITY CONNECTION PERMIT
�
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,. wn�te File pERMIT NO. �Z �'J� (�
2. Pink Ciry
� 3. Yellow Applicant
(Please e or rint and si at bottom)
ADDRESS ZONING (ot�'ice use)
S 3 �-[ w��) a f�ri�. N�
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(NameE v`� �- � � S �"V � (Phone)
(Address)
BUII,DER ],,,._� f� ��� ,,,,,�[ .�. � � � �� '�t � � � � ��
(Company Name) AI � �11Ow�C ��Ol�i' 1 l,I P�S��✓�� l(� (Phone)
(Contaet Name) � 1 2e �`'� A/�'� (Phone) �( 2 � 3 S" 7� 2�
(Address) � Z.Q T LJQ,I D nti'2 M r �'V S�`'► �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �e-Roofing ❑Re-Sidinig ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration �Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc:
Type of Constirnction: I II III IV V A B .�
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE ���� � �.
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have Cumished informadon on this applicaflon which is to the best of my I�owledge aue aud coned. I also cerdfy that I am the owner or authorized ageut for the
above-mentioned prope that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I azn awaze that the building
official can revoke ' e' for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perfoan ueeded inspections.
� �"_ �3C 6�5� � 5 ���3arZa�z
X
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 DiJE $
This Applicadon Bewmes Your Building Permit When Approved Paid Recei t o.
Date B
Buildin Official Date
This is to certify that the request in the above applicaflon and accompanying documents is in accordance with the City Zoning Ocdinance and may proceed as requested. This document
when signed by the City Planner consfitutes a temporary Certificate of Zoning compGance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date Special Condidons, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372