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�� '� 9 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec d
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" �� `�' AND UTILITY CONNECTION PERMIT
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�. Wh��e File pERMIT NO.
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3. Yellow Applicant
Please ty e ar rint and si at bottom
ADDRESS ZONING (ot�ce use)
S 3�S ��,no�- 2 t7 5� �
LEGAL DESCRIPTION (oflf'ice use only)
LOT BLOCK ADDITION PID
�J e� S�,t� �o.� � i tt�n.e,� (Phone) '�'1 S�oZ'a� 3�—,��� �
(Address) �3 r
BUII.,DER
(Company Name)� or 6�� r� �,�� (Phone) �S`� — �S�'7 �� 3 f
(Contact Name) ` �a:w� tS U �ar (Phone) C� ���/
(Address) / �' ,, O'
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �te-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
DAddition DAlteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc:
Type of Construction: I II III IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COSTNALUE $ �� p�
Division: 1 2 3 4 5 (exclnding land)
I hereby certify that I have fumished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above-mentioned property and that all conmuction will conform to all existing state and local laws and will proceed in acwrdance with submitted plans. I am aware that the building
official can revoke this permi just cause. Furthermore, I by agree that the aty official or a designee may eater upon the pmperty to perform needed inspections.
,�e � Ys��y� ��� `2
X_ , _
Signature Conh�actor's License No. Date
Permit Valuarion 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 Pernut Fee $ Builder's Deposit $
Sewer 8c Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ .,
This Application Becomes Your Bnilding Permit When Approved Paid . Recei t NO.
Date B
Buildin Official Date
This is to certify that rhe request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner consritutes a temporary Certificate of Zoning compliance and allows construction to wmmence. Before occupancy, a Ctrtificate of Occupancy must be
issued.
Planning D'uector Date Special Conditions, if any
24 honr nof3ce for all inspections (952) 447-9850, fas (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372