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D
o � PRtp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
U �rj
'6� A, P 1. White File
• � , �;�� �,� PERMIT NO. I'1-' l� y�,�
± Yellow Applicant
Please e or rint and si at bottom
ADDRES ZOI�TING (otT,cc nse)
L lO(�� � �i,�odQ ��� � �
LEGAL DESCRIPTION (o�ice use onty)
LOT BLOCK ADDITION PID
�WNER �/ � � ��/� (Phone) �,��' /�J'' ! �� �
�
(Address) L C 6 ��.���� �%J ��• i �
CompnyRName) C� � �.__ (Phone) �� �✓�� �✓�JD
(Contact Name D�. (Phone) �l �c� � 7 Gl�`" s.3s�
(Address) � 0 � �� .5 � G-,� �� � �,/� �Ls !'1./ S J 37
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Uriliry Con ction
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III N V A B m ��
Occupancy Group: A B E F H I M R S U PROJECT COST/VALITE $,,��
(excluding land)
Division: 1 2 3 4 5
1 hereby certify that 1 have furnished information on this application which is to the best of my knuwledge true and currect. I also certify that 1 am the owner nr authorized agent for the
above-menuoned properry and that all constraction wiU conform to alt existing stare and loca! laws and will proceed in accordance with submitted plans. 1 am aware that the buildmg
� official zan oke this prrmit for jus use Furthermore, I hereby agree that the ciry official or a drsignee may enter upon the property ro prrform necded mspecnons.
X C.06��'��
Signa Y Contractor's License No. Date
Permi Valuation Park Support Fee # $
Permit Fee $ SAC # $
Ptan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $ -
Plumbing Perrnit 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 Build'u1g Pennit When Approved Paid Recei t O
Date ,C,j B
Buildin � Ui'ticial Date
Thu �s to certify thu thc requcst in the abuve applicanon and accompanying documents is in accordance with the City Zoninb Ordinance and may pr�xred as rcqucsted. Th�s document
when signed by the Ciry P(anner consututes a remporary Certificau of Zoning compliance and alluws construction to commence. Before uccupancy, a Ceit�ficate of Oecupancy must be
issucd
Planning Director Date Special CondiNons, if any
24 hour noticc for all inspections (952) 447-9850, fax (9S2) 4A9-4245
4646 Dakota Street Prior Lake, MN 55372