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� � CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" �' AND UTILITY CONNECTION PERMIT
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l �'NES��
�. Wh��e File pERMIT NO.
2 P,,,k �,� iz - i� �7
3. Yellow Applicant
Please or ' t and si at bottom
ADDRESS ZONING (office use)
� �-I I � � I�u� e r5 f . ,(J �
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
owr�R '�rv ( Cc�v�p�-,-� ((o�z��/—�.32
ame (Phone)
(Address) ��-} �$ S l,�'� -� i� S �. I v� ►r I[�V s�3 -] Z
BUII,DER f1
(CompanyName) �l DW��S I/11�E . � Vl C • (Phone) �(� 12)353 —S� 81
(Contact Name) M 1�- N�� �� (Phone)
(Address) Z Q Z� -I .� � � S �"" 01� �S �!
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �Re-Roofing ORe-Siding ❑Lower Level Finish ❑ Fireplace
QAddition QAlterarion ❑Utility Connection
CODE: DI.R.C. ❑I.B.C. ❑ Misc:
Type of Construction: I II III rv v A B
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE � � � DO v
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished informadon on this applicadon which is to the best of my laiowledge true and correct. I also certify that I am the owner ar authorized agent for the
above-mentioned properry and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am awaze that the building
official can revoke this pennit far jus ca e. Furthermore, I hereby agree that the city official or a designee may enter upon the properry to perform needed insp 'ons.
X Gti i� ���-P �C 5 �f 1�
Signature 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 $ . 7�
This Applicatlon Becomes Your Bu�ding Permit When Approved Paid Recei t O
Date B
Buildin Official Date
Z'his is to ceitify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
whrn signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 6our notice for all inspecHons (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372