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oF PR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� X AND UTILITY CONNECTION PERMIT
U �
��A'NESO�� �. wn��e File pERMIT NO. !�_�i�
2. Pink City
3 Yellow Applicant
Please e or rint and si at bottom)
ADDRESS ��oCj ��.�5� S� ZOI�TING cot�cc u5e>
l
LEGAL DESCRIPTION (oflFice use only)
LOT BLOCK ADDITION PID
OWNER \ � �� � G� 1M 1 �'C )
(Name) J (Phone
(Address) S G�/�Q, cl S �- bo d�
(Comp ny�Name) � � �` � � � �O `�' (Phone) t� � Z — 7 S�� ' � I K /
(Contact Name) � L � ( (Phone)
(Address) ? J 1 S � �/►-� �V � S �' �- dVl S P �— M N � S �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �e-Roo6ng ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Conn ction
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III N V A B pR03ECT COSTJVALLTE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have fiimished information on this application which is to the best uf my knowledge true and correct I also certify that 1 am the owncr or authonzed agent for the
above-menhoned properry d that all constniction will conform to all exisnng state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
official evoke this p t for � t cause urthermore, I hereby agee that the ciry official or a designee may enter upon the property to perForm needed mspecuon .
` C Q63�u�Z � 2s Jz
X -
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size SI8"; 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 $
This Application Becomes Your Building Pernut When Approved Paid , Recei NO.
Date B
Buildins Ut7icial Date
This is ro crrtify that the requcst in the abuve applicanon and accumpanying documents is in accordance with the Ciry Zoning Ordinantt and may proceeA as rcqucsted. This ducument
when signed by the Ciry Planner consumtes a remporary Certificate of Zoning compliance and allows construction tu commence. Befure occupancy, a Ccitrticate uf Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9850, fHx (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372