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� � CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" �' AND UTILITY CONNECTION PERMIT (s' S'��-
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I. White File pERMIT NO . y.�
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3. Yellow Applicaut
Please e or rint and si at bottom
ADDRESS ZONING (oft'ice use)
I� � GT �..� M�
LEGAL DESCRIPTION (oflFice use only)
LOT BLOCK ADDITION PID
OWNER
(Name) L��.� �. t/� �- 21� 2T [''�...4a� _ (Phone) 9S �. 3�� • ���G
(Address)
BUII.,DER
(Company Name} �L+2�Gf�} �'rc7`��.�DYz- S (Phone) ��-1 (1 �'r�- ��3��-
(Conta.ct Name) `TC� AJ ...��` O :.�- I�E (Phone)
(Address) �8 J� S l-1;��2- f Pl�T l�1 �' � L �, H�`' " r`
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �Re-Roofing e-Siding ❑Lower Level Finish ❑ Fireplace
❑Addidon ❑Alteradon ❑Utility Connection
CODE: �I.R.C. ❑I.B.C. ❑ Misc:
Type of Constructiion: I II III IV V A B /
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $_ � Co ��� �
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above-mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official revok this p 't for just cause. Furthermore, I hereby agree that the city official or a desigiee may enter upon the property to perform needed inspections.
X ���� ,��-�— (
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 $
This Application Becomes Your Building Permit When Approved Paid Rec � t No.
Date � � B
Buildin Official Date
This is to certify that the request in the above application and accompanying documents is in accordance with the Ciry Zoning Ordinance and may proceed as requested. This document
when signed by the Ciry Planner constitutes a temporazy Certificate of Zoning compliance and allows consiruction to commence. Before occupanty, a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (95Z} 447-9850, fa$ (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372