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oF PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� �. TEMP4RARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
U �
��n'NES��r I, White File �
2�;�� �;, PERMIT NO. �. �' ��C� i
+ Yeilow Applicanl
Please or rint and si at bottom)
ADDRESS ZONING (ott'ice use>
!� � � ��t � - �
LEGAL DESCRIPTION (oflf'ice use only}
LOT BLOCK ADDITION PID
OWNER - 1
(Name) �e�l � �1:�1� (Phone)
(Address)
BUILDER ,�.,�,` n
(Company Name) ,,�� !„ �+ f �alr- Y(Z�P-2R� � iRYZ�"'�U �� (Phone) �� _ !� �� � � `t>7
(Contact Name) CihGS` �=1 ���.`''' (Phone} �4 '3 ^ `l'� " � �+
(Address) '�2.8 `!� <,�+^ � f. , � nc,� �j ' C1.
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Levet Finish ❑ Fireplace
❑Addition ❑Aiteration ❑Utility Conneccion
CODE R.c. ❑�.B.c. a M�s�.
Type of C�ction: I II III N V A B pROJECT COST/VALUE � �- �
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hcreby certify that i have fumished information un this appiication which is to the best af my knowicdge true and correct. [ also certify thar I am the owncr or author�zed agent for thc
� above-mennoned properry and that all cunsnuction will conform to all existing state and local laws and will proceed in accordance with submittcd pians I am aware that the buitdmg
ufficial can revoke this permit for�u use Furthermore, I hereby agree that the dty officiai or a designee may enrer upon the property ro perform needed inspections.
I X .� ,�� �-(0 3 5� ��� `� � 1 �J' �7�)�-
Signature Contractor's License No. Date
Permit Valuation �._ Park Support Fee # $
.
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size S/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 Firepiace Fermit Fee $ TOTAL DUE �
.
This A ati n Becomes Your Buitding Permit When pprov d Paid Recei t NO.
Date B
uil in�!Utficia z � ('� S� (0( � f, �
This �s to cercify that the requcst m f e a ove a p �ca �on and accumpanying documents is in accordance with the Ciry Zuning Ordinance and may proceed L` requcsted. Th�s ducument
when signed by the Ciry Planner conshtutes a temporary Certificate ot Zoning c�mpliance and allows construction tu commence. Befure �xcupancy, a Ceruficam of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour notice Por all inspections (9i2) 447-98St1, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372