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oF ext CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
U �
��'VNESO�� i. wn��e File PERMIT NO . C t��
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ADDRES5 ZONING (o� use>
U�l �, b�'�d. C�` L
LEGAL DESCRIPTION (office use onty)
LOT BLOCK ADDITION PID
OWNER � /t �- C7 W r��
(Name) (Phone)
(Address)
$IJILDER (� �
(Company Name) „� �J� � r�� y'2��v'� (Phone) '"'�C� `3 ^ u �� " ��
(Contact Name) C��l�'�� �LC�lS��2�' (Phone)
(Address) ^v �„c� ,r � 5 �Q e7
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utitity Conne io
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of ConstYUCtion: I II III N V A B pROJECT COST/VALIJE S
Occupancy Group: A B E F H I M R S U
(excluding land)
I�vision: 1 2 3 4 5
! hereby certify that [ have fumished information un this application which is to the best of my knowledge true and correct. [ also cenffy that I am the owncr or authonud agent fur thc
atwve-mennoned property and that all construction will conform to atl existing state and local laws and will proceed in accordance with submitted plans. 1 am awaze that the buildmg
ufficial can rrvoke this permit for just cause. Furthermore, I hereby agree that the city ofFiciai or a designee may enrer upon the propecty to perform necdcd mspcctions.
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Signature Conuactor's License No. Date
Permit Valuation �, s Park Support Fee # $
Permit Fee $ � � Z �- SAC # $
Plan Check Fee $ � Water Meter Size 5/8"; 1"; $
.
State Surcharge $ � Pressure Reducer $
.
Penalty $ 5ewer/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 DIJE $�
.
This A 1' a' B�rnmes Your Buitding Pe�mit ea A ved Paid ReCel t NO. �
Date B
�
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Thls ic to certify that the requcst in fhe above applicahan and accumpanymg documents is in accordance with the Ciry Zoning Ordinance and may proceed as requcxecd. This document
when signed by the City Planner constuutes a temporary Certi6cate of Zoning compliance and aAows construction ro commence. Before �xcupancy, a Ceruficate nf Occupancy must bc
icsucd.
Planning Director Date Special Conditions, if any
24 hour notice for alf inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
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