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oF PRI�� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� X AND UTILITY CONNECTION PERMIT
U �
'yjpNESO4t' I. White File pERMIT NO.
2. Pink City �L �� � 7 9
3 Yellow Applicant
Please or 'ttt and si at bottom)
ADDRESS ZOIVING (office use)
� � �,/- � �' �(,( l �0' �;�� �1 .` '' L � =
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
O a WNER �� f T °-� �'l �' 1 "� � � cL- ��- �"''�J C-�.J' (Phone) ��� �.�(� '7 ���
(Address) 1. c� ��i, �r (�q, � f'rr. , 1� ^ : �-! (�-, l�a.-
BUII,DER t � � �� � �.� �s a -�,� �_ � � �. �
(Company Name) (Phone)
(Contact Name) �t .S +� (Phone)
(Address) . � � � C,r� � / " � �'/
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch - oo6ng ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteradon ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III N V A B �,) �
Occupancy Group: A B E F H I M R S U pROJECT COST/VALUE $
Division: 1 2 3 4 5
(excluding land)
I hereby certify that I have fumished mformation on this application which is w the best uf my knowledge true and correct. 1 alsu certify that I am the owncr or authunzcd agent for ttie
above-menuoned,properry and that a struction will conform to all existing state and local (aws and will proceed in accordanee with submitted plans. I am aware that the buildmg
official can revo this permit for y � use Furthermore, I hereby agree that the city official or a designee may enter upon the property ro perform necded mspections.
X
Signamre Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 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 Fireplace Permit Fee $ TOTAL DUE $ 9 7
This Application Becomes Your Building Permit When Approved Paid ReCei t �
Date � B `
Buildim� Utlicial Date
This rs to certify that the requcst in the abuve applicauon and accumpanying documents is in accordance with the Ciry Zoning Ordinantt and may pri�tted as requcsted. This document
when signed by the Ciry Planner consumtes a tempurary Certificate of Zonmg compliance and allows construction to commence. BeFore occupancy, a Ceruficate of Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372