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��-�� PR I �'� CITY OF PRIOR LAKE BUILDING PERMIT Date Rec'cl
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�; f!i `� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ( S ��
"� f'\'�' A N D U T I L I T Y C O N N E C T I ON PERMIT �
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l. White File pERMIT NO. �Z / � j
2. Pink City � � �(� J�
3. Yeilow Applicant .
lease e or ' t and si at bottom
AnDRESS ZONING (ot�'ice use)
`J� � 1 5 .YZ.�'�SS � �:�t�i2.._.� S�". S � ,
LEGAL DESCRIPTION (oflece use only)
LOT BLOCK ADDITION PID
OWNER �
(Name) hl �r�-'� / c� � Sw� ���-u�c� �.ci-t {Phone) �S :�- ` ( l ° I
(Address) � 7 t Cr� s w� �� ie.►� �� • S E.��► o+e�. c�c�.�. �.. rc� N.�� 3 �
BLJbDER
(Company Name) �TU�e:ti�r> ° �L - �� cz.� '�S� �Cr� LLiC-- (Phone} (oS l'�.3� - l �o��
(Contact Name) � O � L '� � V� �� (Phane} 7�.� 3��� - �* - 1���� R� �
(Address) i 3 S S��aUF�v t� 1 N� S w� �U D PS Kl� '� rv . S a�
TYPE OF �VORK ❑ New Construcaon []Deck ❑Porch �Re-Roofing �Re-Siding OLower Level Finish ❑ Fireplace
(]Addirion []Alterarion (]Utility Connection
CODE: �I.R.C. �I.B.C. �Misc:�PSC-�'�' 4'�C-K O�' �U��- v�'�''`�
Type of Construction: I II III IV V A B �
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE S� 3 �� ��` �' �
Division: 1 2 3 4 5 (excluding lan�
I hereby cercify that I have furnished information on this application which is to the best of my knowledge uue and conect. I also certify that I am the owner or authorized agent for the
above-mentioned pmperty and that all conswction will confomi to all exisdng scace and Ioca1 laws and will proceed in accordance with submitted plans. I am aware that tNe building
official can revoke this permit for just cause. Furchem�ore, I hereby agree that the city official or a designee may enter upon the pmperty to perforni needed inspections.
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S 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 ConnecCion Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other S
Gas Fireplace Permit Fee $ TOTAL DUE $
Tlus Application Becomes Your Building Permit When Approved Paid • R ei t No.
Date > � - /L ,
Buildin Official Date
This is to certify that the request in the above application and accomQanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This documrnt
when signed by the City Planna wnsatutes a temporary Certificate of Zoning rnmpliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions, ifany
24 hour notice for all inspections (952) 447-9850, fax {952} 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372