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� � CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" i � AND UTILITY CONNECTION PERMIT
�
l �'NES��
1. White File ��71�,t7rr �7� 7
2. Pink City Al�'ll l Lr / L� j� +� /
3. Yellow Applicant '`l
lease e or rint and si at bouom
ADDRESS ZONING (otTice use)
f� � ,:S"�
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDTTION PID
OWNER
(Name) ���y ���e''� (Phone) �oJ�� �'�� �o � 3 ?
(Address) Q,5 �"SA��i2-�¢- '7��c E�7� ldlir L /�'J� 7�+
BUII.,DER J' �� � �'o,SI �loS8�63 �S
(Company Name) K/�_ ���/ f��s _ (Phone)
(Contact Name) � Ja.1 �D i rt,p—� (Phone) �O �� �oss�.37 �
(Address) � �p� � �%/��fT.S /� '1
TYPE OF WORK ❑ New Construc[ion ODeck �Porch e-Roofing ❑Re-Siding �Lower Level Finish ❑ Fireplace
�Addition ❑Alteration ❑Utility Conn 'on
CODE: �I.R.C. ❑I.B.C. ❑ Misc:
Type of Constcuction: I II III N V A B �����
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ �
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information on this apptication which is to the best of my lmowledge true and correct. I aLso certify thaz I atn the owner or authorized agent for the
above-mendoned properry and that all oonstruction will conform to a11 existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revok ' for jus au Furthermore, I hereby a@�ee thaz the city official or a designee may enter upon the pmperty co perform needed inspections.
X ��--''' �3� �.3,�� 9°� ~��
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Siae 5/8"; 1"; $
State Surchaxge $ 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 $
Tltis Application Bemmes Your Building Permit When Approved Paid Recei t NO.
Date L B
Buildin Official Date
T'his is to certify that the request in the above application and accompanying document4 is in accordance with the City Zoning Ordinance and may proceed as requested. 77ris document
when signed by the City Planner constitutes a temporazy Certificate of Zoning compliance and allows mnstruction to rnmmence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Diredor Date 3pecial Conditions, if airy
24 hour notice for all inspections (952) 447-9850, faz (952) 447-4245
4646 Dskota Street S.E., Pr[or Lake, Minneaota 55372