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�� �'� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec d
� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� °" AND UTILITY CONNECTION PERMIT
�
� S S��
�. wh,�e File pERMIT NO.
2. Pink Ciry � . � �
3. Yellow Applicant �/ �
lease e or rint and si at bottom
ADDRESS ZONII�TG (oe'ice use
°// �'�.'
LEGAL DESCRIPTION (ofl['ice use only)
LOT BLOCK ADDITION PID
OWNER _
(Name) ,L�L� l�efj��/� _ (Phone) �o,/��j�,l„
(Address) � l� ,s�
BUII.,DER �
(Company Name).�/Jfil'�i�� GO:�/1�5 C��/J/l� (Phone) �� '
(Contact Name) ��%rQ �l'.-�Ht� (Phone)
(Address) ,�jci �7�' ,S'/Q7
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing �Re-Siding �Lower Level Finish ❑ Fireplace
❑Addidon �Alteration ❑Utiliry Connection
CODE: ❑I.R.C. ❑I.B.C. �Misc: �/�//x'/dLl� /�l�T
Type of Construcdon: I II III IV V A B• /� /��
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ i
Division: 1 2 3 4 5 (excluding land)
I hereby certiCy that I have furnished information on this application wluch is to the best of my lmowledge true and coirect. I also certiTy that I azn the owner or authorized agent for the
above-mendo all �nstruction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the lwilding
official c is jus use. Furthermore, I hereby agee that the city official or a designee may enter upon the property to perform neede
X �/'�'�Q3
ignature 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 Application Bernmes Your Building Permit When Approved Paid Recei O.
Date B
Buildin Off"icial Date
This is to certify that the request in the above application and acwmpanying documents is in accordance with rhe City Zoning Ordinance and may proceed as requesMd. Tlus document
when signed by the City Planner wnstitutes a temporary Certificate of Zoning compliance and allows construclion to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions, if my
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372