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�% P R I�'� CITY OF PRIOR LAKE BUII.DING PERMIT, Date Rec' d
�� ��' TEMPORARY CER T I F I C A T E O F Z O N IN G C O M P L I A N C E
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,�; , AND UTILITY CONNECTION PERMIT
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1. White File pERMIT NO .
2. Pink City l Z. r-�
3. Yellow Applicant
ease � e or t and si at bottom
ADD SS . ZONING (omce use)
Co �q�' s�-� �� S �
LEGAL DESCItIPTION (office use onty)
LOT BLOCK ADDITION PID
OWNER(�� J,,,� �+,, (,
(Name) l.� � f�-U/E� ��j�( (Phone) ,�� 'aa� 'oZ�aC�
(Address) �C.Y .� G�I��.;Sl�� �Y`�� � /'� .S� �
BUII.DER �//-
(Company Name) �m -Pld�)� (Phone) �pS� � �C�� 07� 7�P
(Contact Name) «�� (Phone) J
(Address) � L � �. ,�, o / Y
TYPE OF WORK ❑ New Construction �Deck �Porch �Re-Roofing �]Re-Siding �Lower Level Finish ❑ Fireplace
❑Addition �Alteration �Utility Connection ' �
CODE: �I.R.C. ❑I.B.C. Misc: �1 �CACUJ��� �f 1 U(:!'��
1�pe of Construction: I II III IV V A B � �
Occapancy Grnup: A B E F H I M B S U PROJECT COST/VALUE S 6� �� -w
Dirision: 1 2 3 4 S (ezcluding land)
I hereby certify that I have fiunished information oa this applicaaon wlrich is to the best of my knowledge true and corred. I aiso certify that I am the owner or authorized agent for the
above-menponed property and that all construction will conform to all existing stare and local laws and witl proceed in accordance with submitted pians. I am awaze that the building
official can revok this pemut for 'ust cause. Furthermore, I hereby a�ee t6at the city officiai or a desiguee may enter upon the property to perform needed inspections.
X �� � �ooe7�� �-a - /2
Signat� Contractor's License l�io. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surchazge $ 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 $
T� APP��� �m� Y� ��S P� �� APP�� Paid Recei t No
Date B
Buildin Official Date
This is to cerdfy that the request in the above application and accompanying documentc is in accordance with the City Zoning Ordinance and may proceed as mquesced. 1'his docament
when signed by the Gty Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before ocxupancy, a Catificate of Occupancy must be
issued.
Planning Director Date Special Conditions, if auy
24 Loar notice for all inapectiona (9S2) 447-9850, fai (952) 447-4245
4646 Dakota Strcet 3.E., Prior Lwice, Mlnneaota 55372