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o � rR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
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AND UTILITY CONNECTION PERMIT S' Z�' � Z
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z �;�, � PERMIT NO.
3 Yellow Applicant � 1
Please or rint and si at bottom
ADDRESS ZONING (ott'ice usc)
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LEGAL DESCRIPTION (oflE'ice use only)
LOT BLOCK ADDITION PID
OW1vER `,
(Name) � r �`' � �v�o��----� �` (Phone)
(Address)
BUII.,DER
(Company Name) � . r-- j d� (Phone) � )v� " 7 7'� " � �� �
(Contact Name) e�-� � ` (Phone)
(Address) �- �l -� S � L�
TYPE OF WORK ❑ New Construction �Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alter ion ❑Utility Connection /�� , / � / ' �
❑ M�s�. DG ��-- �Q./�' �� ��
CODE: ❑I.R.C. ❑I.B.C. .
Type of Construction: I II III N V A B pROJECT COST/VALUE $
Occupancy Group: A B E F H I M R S U (excludingland)
Division: 1 2 3 4 5
I hereby certity that I have fumished infurmation on this application which is w the best uf my knowlcdge tnie and mrrect. I also ceRify that I am the uwncr or authonzed agent for thc
alwvo-mentioned property and that all construction will conform ro all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
official can revoke this permit for ust cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed mspections.
' �LS�s3 �� 3
X .._ s =a �- � �
Si re Contractor's License No. Date
Permit Valuation �_(f� Park Support Fee # $
Permit Fee $ ZS�� Z SAC # $
Plan Check Fee $ `� . Z f� VVater Meter Size 5/8"; 1"; $
State Surcharge $ S � 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 Pernut When Approved Paid • R ei t No.
Date
Buildim� Utlicial Date
Th�s �s to certify that thc requcst in the abuve applicauon and accompanying documents is in accordance with the Ciry Zoning Ordinancc and may proceed as rcqucsted. Th�s documcnt
when signed by the Ciry Planner consututes a temporary Certificate uf Zoning compliance and alluws construction ro commence. Before occupancy, a Certificate of Occupancy must be
ISSUI`Ci.
Planning Director Date Special Condi[ions, if any
24 hour noticc (or all inspections (952) 447-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372