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� 04 rK� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
U �
��NArES��h I Whi�e File n
� �,n, �„ PERMIT NO. �'z �� �/L, �
; Yeliow Applieanl
P(ease or rint and si at boitom)
ADDRESS ZONING {oftsce use�
J ' � ; Gt. - { ; � � � ��j . ,� �,,.
LEGAL DESCRIPTION (office use only)
LUT BLOCK ADDITION PID
O WNER / ' � -�' �� ��
(Name) l�(`�' ' (Phone) �i/� --(� � �-°,
(Address) � �J � � � f - �? � ' . 'l-� Y �l � �J /C " .
.
BUILDER �„��„t.._ ,
p � , ` s t ) �_� �1� z ��--.�7�.�
(Com an Name) '�' � �-- Phone
(Contact Name) xl fi �^ t� v .c (Phone) S� v� 1�.
(Address) (1C � � ? C� E? 0 YCJ C� C � J`� L-
TYPE OF WORK � New Construction ❑Deck ❑Porch ❑F.e-Roofing e-Siding ❑Lower Level Finish ❑ Fireptace
❑Addition ❑Alteration ❑Utility Connection
�� � J � ,
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc. �iV r''��u ) � �E —��rG G
Type of Conslruction: I II III IV V A B pROJECT COST/VALIJE $ �
Occupancy Group: A B E F H I M R S U
(excluding Iand}
Division: 1 2 3 4 5
[ hereby cv:rtify that i have fiunished infi�rmation on this apptication which is ro the best of my knowtedge trtie and correct. ! also cerufy that 1 am the vwner or authonud agent for the
abovamcnhoned propc�Yy and that all cunstruction will conform ro atl existing state and local laws and wiA proceed in aceordance with submitted plans. I am aware that the building
ufficial can revoke this permit for just cause Furthermore, [ hereby agree tfiat the city o�cial or a designee may enter upon the propeny io perform necded inspections.
X
Signature Conttactor's License No. Date
Permit Valuation Park Suppon Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Piumbing Permit Fee $ Water Tower Fee # $
Mechanicai Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Firepiace Permit Fee $ TOTAL DL7E $
This Appiication Becomes Your Building Permit When Approved Paid � Recei t N.�
Date B
Buildine Utiicial Date
This �s w certify that the requcst in the above applicanon and accumpanymg documents is in accordance with the Ciry Zoning Ordinance and may pnxeed as requcs[ed. This ducument
when signed by the Ciry Ptannee consumtes a temporary Certificate of Zoning compliance and apows constructiun tu commence. Before occupancy, a Ccruticatt of Occupancy must Ix
issucd.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447AAS0, fax (952) 447-4245
4646 Dakota Street Prior I,ake, MN 55372