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� �' CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� D� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" AND UTILITY CONNECTION PERMIT
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1. White File pERMIT NO .
2. Pink City J ) —�/� �
3. Yellow Applicant � J
ease e or and si at bottom
ADDRESS ZONING (otsce use)
(� 2 2 �� S 1�,� �� ��.w N�'
LEGAL DESCRIPTION (otiice use only)
LOT BLOCK ADDITION PID
�� ER rl �1l�li �r�'(J�`� � (Phone) � �G y 7 � � ` � 2 Z
i� 1
(Address) � �� �7iJ� 5 � �-G-� �ti� /l/ �i �l �� � ��j /''I�N S 37 Z
BUII..DER � �/ - 7 � _ � � l /
(Company Name) �'' � ��� (Phone) < <
(Contact Name) �'� (Phone)
(Address) 2-�� ���`" /�l/ti� �/ � ��1� v�'�� S�- w✓� M GG��I
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �Re-Roofing �Re-Siding ❑Lower Level Finish ❑ Fireplace
DAddition ❑Alteration ❑Utility Connection —
CODE: ❑I.R.C. �I.B.C. �lviisc: L �% ! U% �" �
Type of Constiuction: I II III N V A B 3 u/� /A
Occupancy Group: A B E F H I M R S U PROJECT COST/YALUE S U �
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information on this application w}uch is to the best of my lmowledge true and corred. I also certify thaz I am We owner or authorized a�nt for the
above-mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitt� plans. I am aware that t6e building
official can revoke 's permit just cause. F� eimore, I hereby agree that the city official or a desi�ee may enter upon t6e property to perform needed inspections.
x " �3G 3�"6Y �7 - 7-23-�2
S' Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surchazge $ 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 $
T6is Application Becomes Your Building Permit When Approved Paid ReCCi t o.
Date � B
Buildin Official Date
This is to certify that the request in the above applicaaon and accompanying documrnts is in accordance with t6e City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificace of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour notice for all inspecl3ons (952) 447-9850, faz (452) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372