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oF PRtp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
F � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �/_ ��
AND UTILITY CONNECTION PERMIT �
U �
�
��A'NESO�� ' White File pERMIT NO.
. Pink City /Z /��.
3 Yellow Applicani �.
(Please e or rint and si ar bottom)
ADDRESS ZONING c���� �St�
3 0 ' �
,w
LEGAL DESCRIPTION (office Use only)
LOT BLOCK ADDITION PID
OWNER �/ /` r (� �,/
(Name) ��,�!�— �1 � U S V b V`V � �� � (Phone) 1��Lyo ' s �7'6 7
�
(Address)
� BUII.,DER ^-
(Company Name) -� � � � (Phone)
(Contact Name) 6� (�� �� a� D G t/ (Phone) 7J 2�7�0 "J 3�
(Address) (, +� �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �I2e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utiliry Connection
CODE: ❑I.R.C. ❑I.B.C. Cl Misc.
Type of Construction: I II III IV 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 hereby certify that 1 have fumished information on t is application which is to the best uf my knowledge true and correet. 1 alsu eertify that 1 am the uwner or authonzed agent for the
abuve-mennoned propeity and hat all construction ill conform ro all existing stare and loca! laws and will proceed in accordance with submined plans. I am aware that the buiidmg
ufficial can rev • this perm t r�ust cause Furth more, I hereby agree that the ciry official or a designee may enter upon the property to perform needed mspectYuns.
� X '�LC�:�L3�d �r � `
Signatu Contrattor's License No. ate
Permit Valuati Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; I"; $
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 Fireplace Permit Fee $ TOTAL DUE $
This Application Becomes Your Building Permit When Approved Paid ' R e' t No.
Date �r,. 7v- B
BuilJim± Ufficial Date
Th�s �s to certify that the requcst in the abuve application and accumpanying documents is in accordance with the City Zuning Ordinance and may pr�xeed as requcsted. This ducument
when signed by the City Planner consn[uta a remporary Certificate of Zoning compliance and alluws construction to commence. Befure uccupancy, a Ceitrticate of Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour noticc (or all inspections (952) �47-9850, fax (952) 4�t7-4245
4646 Dakota Street Prior Lake, MN 55372