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o � PRtp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� �. TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
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�t�NlSOK�' I. Whi�e File ` �_ j �^��
Z r;,,, C;, PERMIT NO. � U
r 3 Yellow Aypiieam / t
Please or rint and si at bottom
ADDRESS ZOI�TING (oet'ice use>
�n � i O 1.�.� � =� � l� �
LEGAL DESCRIPTION (ofFice use only)
LOT BLOCK ADDITION PID
OWNER,� � �p�
(Name) � �_�rJ t �_ T,� �`���� (Phone) �e� l � � � � �"' � - 7 g'�
(Address) � �
BUILDER `
(Company Name)��,j� , !`6�'Tf�� C�;�� ��.nC.. (Phone) a, �J' o� '��,� �7 C� �
(Contact Name) �n, pf�.�,�ffY�: (Phone) Sc���
(Address) - �=
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑I2e-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utitity Con❑ ccioa
CODE: ❑I.R.C. DI.B.C. 0 Misc.
Type of Construction: I II III N V A B p� ��
Occupazxcy Groap: A B E F H I M R S U PROJECT COST/VALtJE $�� � O
Division: 1 Z 3 4 5
(excluding land)
I hereby ccrtity that [ have fumished mfi�rmation on this applicacion which is to the best of my knowledge mte and conect. 1 also cectify that I am the uwner or authunzed agent for the
alwve-mentioned proprrty and that all cunstruction will conform ro atl existing state and local laws and wiil proceed in accordance with submitted plans. I am awarc that the buiidmg
ufFiciat can revoke thi it for jus se Furtheimorc, I hereby agree that the dty officiat or a designee may enter upon the property to pcn�form necded enspections.
X ___�-_� l� a S� �} -1�( -► 2._.-
Si ture Contractor's License No. Date
Permit Valuation � S' Park Support Fee # $
Permit Fee $ � t,� � s SAC # $
Plan Check Fee $ Water Meter Size 5/8"; i' ; $
State Surcharge $ d � Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Buiider's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Perrnit Fee $ TOTAL DiJE $
This A licarion Becomes Your Building Perndt When Approved Paid G ReCei t No.
j`/ � Date B
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Buildine Utticiai Da �
This u to certrfy that the requcst in the abuve applicanon and accumpanying documencs is in accurdance with the City Zoning Ordinance and may protted a� rcqucsted. This ducument
when signed by the Ciry Planner consutuces a temporary Certificate of Zoning comptiance and allows c<mstruction ta commence. Beforr ��ecupancy, a Ceruticate of Occupancy must be
i,�ucd.
Planning Director Date Special Conditions, if any
24 hour noticc for ail inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
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