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oF pR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE � rC f�
.. � AND UTILITY CONNECTION PERMIT
U �
;��1hES0�� I. White File
z�;�� c;� PERMIT NO. � 2, , l� C�'
, Yeliow Applicant
Please or rint and si at bottom
ADDRESS ZONING (otfice use>
/ C . ,e.�z-
LEGAL DESCRIPTION (ofFice use only}
LOT BLOCK ADDITION PID
OWNER�-�- //
(Name) --�1 /`� � ��'�E' S (Phone) 7,(p3 � 10.�3 - 5 3B'!e
(Address) p ,E^.► � pd � �- itJ �j
BUII.DER /
(Company Na �v E.��r �G•r� (Phone) �o/Z' �90 � `�7�,(�
(Contact Nam (Phone)
(Address) .� . �� _ t HJ �.�. �� -S
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Firep(ace
❑Addition ❑Alteration ❑Utiliry Con tio
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B pR03ECT COSTJVALUE $�26[�
Occupancy Group: A B E F H I M R S U
(exciuding land)
Division: 1 Z 3 4 5
S hereby certify Shat [ have Sumished information un this application which is to the best of my knowtedge nue and correct. i afso certify that f am the uwn�7 or authortzed agent fa tfie
above- enti ned property and that all construction will cpnform ro atl existing state and local laws and will proceed in accurdance with submittcd plans. I am aware that the buildmg
ufficial an re e this permit for just cause- Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform necded msprctio s.
X �---- � G S'3��— `� �
Signature Contractor's License No. Dace
Perm� Valuation Park Support Fee # $
ermit 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 Pee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $
Titis Apptication Becomes Your Building Petmit When Approved Paid � ' t No.
Date � a
Buildin � Utticial Date
Thu u to certify that the requcst in the above applicauon and accumpanying documents is in accordance with ihe Ciry Z.�ming Ordinance and may q'oceeA as requcsted. This ducument
when signed by the Ciry Planner cunshtutcs a tempurary Certificate of Zoning compliance and allaws consm�ction tu commence. Befure occupancy, a Certiticatc of Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hoor noticc for all inspections (952) 447-9RSp, fax �452) 447-4245
4646 Dakota Street Prior Lake, MN 55372