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�� PR CITY OF PRIOR LAKE BUII.DING PERNIIT, Date Rec'd
��! \� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
�� � �
"�!C �% �' AND UTILITY CONNECTION PERMIT
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]. White File pERMIT NO .
z. r��k ary � Z._.� �/3,�
3. YeOow Applicant /
ease or ' t and si at bottom
, ADDRESS ZONING (oeece use)
I'�I � �/ S� � r L �.j 3'
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER ( � G
(Name) l� (Phone) ��� -�J�/��Q�7
(Address) � "� �� � � � Y�� �� ,SJ`� ��
BUII.DER /,,�,, J I ,�/ ' /�
(Company Name) ��1 (Phone) l�d�/ ` 7�Y '°�� YCO
(ContactName) li(� (Phone) "
a(Address) h� � .,� . U � Q/L
' TYPE OF WOBg ❑ New Construction ❑Deck []Porch ❑Re-Roofing (]Re-Siding ❑Lower Level Finish ❑ Fireplace
�Addition �Alteradon ❑Utility Connection
CODE: ❑I.B.C. �I.B.C. E�Misc: � �G
1�^pe of Construction: I II III IV V A B r �
Occ�tpancy Group: A B E F H I M R S U PROJECT COST/VALUE S ��-/ Sl •�
Division: 1 2 3 4 5 (exclading land)
I hereby certify that I have furnished information on tLis application which is to the best of my knowledge true and corred. I also certify that I am the owner or authorized agent for the
above-mentioned property and that all construction will conform to all existing state and local laws and will pmceed in acmrdance with submitted plans. I am awaze that the buildiag
official can re ke this erm�t for just ca Furthermor I hereby agree that the city official or a desi�ee may enter upon the property to perform needed inspections.
X __����- ��� _��'c� i �G�� � - 9 /�
Signature Contractor's License No. Date
Permit Valuation Pazk 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 Pernut Fee $ TOTAL DUE $ .�
This Appllcation Beoomea Yom� Bnilding Permic Rfien Approved Paid Recei o
Date r S B �
Buildin Official Date
This is to certify that the request in the above application and accompanying documents is in accordance with the Ciry Zoning Ordinance and may proceed ss requesbed. T7�is document
when signed by the City Planner constimus a tempmary Certificate of Zoning �mpliance and allow+s construction to commence. Before oavpanry, a Certificate of Occupancy must be
issued.
Plaming Director Date Spacial Conditions, if my
24 hoar notice for all inspections (952) 447-9850, fai (952) 447-4245
4646 Dakota Street S.E., Prior Lske, Minnaota 55372