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o � rR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ��� �/
� � AND UTILITY CONNECTION PERMIT
�
'djA, I. Whire F�ie pERMIT NO. /'�/
2. Pink City /✓ J/}/.,n
3 Yellow Applicam (.����
Please e or rint and si at bottom)
ADDRESS ZONING (o� use)
.�Z� 7 T�'��C�/�S' �.�rc., c�z.�
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) �-s�ft ��/'��''� ! � (Phone) �Z � , � // �
(Address)
BUII.DER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection C /
CODE: ❑I.R.C. ❑I.B.C. �Misc. � � /v `
Type of Construction: I II III N V A B pROJECT COST/VALUE $
Occupancq Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby ce ' at 1 hav ' ishe informati on this application which is ro the best of my knowledge true and coaect. I also certify that 1 am the uwner or authonzed agent for the
above- ntione pro an at Il constru ion ill conform ro all existing stare and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
offic" I ca perm for t cause F rt}�e�ore, I hereby agree that the city official or a designee may enter upon the property ro perform necded ins ctions.
x �f �
ignamre Contractor's License No. ate
Pe i 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 # $
Piumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Pireplace Permit Fee $ TOTAL DUE $ �� �
This Application Becomes Your Building Permit When Approved Paid ReCei t NO.
Date B
Buildine Ufticial Date /������ /' / ' "� �,vl / ��
This is to certify that the requcst in the above applicauon and accumpanying documents is in accordance with the Ciry Zoning Ordinance and may procred as requcsted. Thls document
when signed by the Ciry Planner consumtes a temporary Certificate of Zoning compliantt and allows construction to commence. Befure uccupancy, a Certificate of Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372 •