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oF rR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE (J �I ��
.�'. X AND UTILITY CONNECTION PERMIT T�
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'yjHNE$�q!' I. Whi�e File
z ����; c�� PERMIT NO. 1� ` 1�
3 Yellow Applicant
Please e or rint and si at bottom)
ADDRESS � ZOIVING (o�t'ice use)
j �.3� �/�� �� �/f�'��
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER /
(Name) ���LL� �.�' t�s� �tv' r (Phone) ��'��i� ~'����
(Address) � 3y / � ,7'ff/- 1' �.�--� �- `''�'
BUII,DER / /�
(Company Name)��( �/� �c''/�S�/�� �/�.C� (Phone) ���"'��
(Contact Name) (Phone)
(Address) ___-' ,Uvsj"'� � � � � � `-if�� C�' r
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch (�e-Roofing ❑Re-Siding ❑Lower Leve] Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction; I II III IV V A B PROJECT COSTlVALLTE $,��
Occupancy Group: A B E F H I M R S U 3 ���
Division: 1 2 3 4 5 (excluding land)
I hereby certity that L have htmished information on this application which is ro the best of my knowledge true and cottect. I also certify that 1 am the uwner or authunzcd agent for the
abuve-menuqt� prope�ty and that all construction will conform to all existing state and local laws and will proceed in accordance with submitred plans. I am awarc Ihat the buildmg
ufficial can �ok� this permit for just cause F thermore, I hereby agree that the city official or a designee may enrer upon the properTy to prrform needed mspections.
x � '� <! /��i l�'� �
ignature Contractor's License N. ate
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
Penalty $ SewerlWater 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 $
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This Application Becomes Your Building Permit When Approved Paid Rec � t No.
Date � !(_ r�
BuilJim� Ufticial Date
This �s ro certify that the requcst in the abuve applicahon and accompanying documents is in accordance with the Ciry Zoning Ordinantt and may proceed as rcqucsted. Th�s ducumcnt
when sigrred by the Ciry Pianner consn[utes a temporary Ce�tificate of Zoning compliance and alluws consn�uction tu commence. Before �xcupancy, a Ceruficate of Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9850, f'ax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372