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o � PR��� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
t`. � AND UTILITY CONNECTION PERMIT
U �
'�►jNNE$0�!' I. White File pERMIT NO. 1 /J
2 Pink City � �-'" � 7 �
3 Yellow Applicant
Please e or rint and si at bottom)
ADDRESS ZONING (ott use)
e `1� �� � i O�.
LEGAL DESCRIPTION (oflfice use only)
LOT BLOCK ADDITION PID
OWNER Y l� „� �
(Name) � ���a ��— 1�.� (Phone)tV I �`��y �^�`�'`�' �
(Address) �`
BUII.DER � � �� �a�� ' ����
(Company Name) T�1 n ��.� �J � '�r1C�,'f-�S�2J(� (Phone)
(Contact Name) (Phone)
(Address) �� o�� CO . �' G C� w��' � `1���. r(1 J�J� ��
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑R - oofin ❑Re-Sidin ❑Lgwer evel Fin�sh Firapla , �/ �
❑Addition ❑Alteration ❑Utility Connection�� l� � _ (�� r�5 � � �w � �
`"1 .
CODE: ❑I.R.C. ❑I.B.C. � M ' .
Type of Conmuction: I II III N V A B pROJECT COST/VALLTE $ �'
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby c rtify that [ have fumi information on this application which is to the best uf my knowledge true and correct. I also certify that 1 am the owncr or authunud agent for the
above- e noned property an that construction wili conform to all existing state and local laws and will proceed in accordance with submined plans. I am aware that the buildmg
( uFficia] revoke this permit r j cause. Furthermare, 1 hereby agree that the c1ty officia� esi�e may ent� n the property to perform nq: • i� ecuuns.
X � a9 � �
Signature Contractor's License No. ate
Permit Vaivation 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 Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $
This Application Becomes Your Building Permit When Approved Paid Recei t N ,
Date 13 Y B
Buildin � Ut�icial Date
This u ro certify that the requcst in the above applicauon and accumpanying documents is in accordance with the Ciry Zoning Ordinance and may protteA as requested. Th�s document
when signed by the City Planner consarotes a temporary Certificate of Zoning compliancc and allows construction to commence. Before occupancy, a Ccrtificate �>f Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372