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� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � ��. / r �--
�
AND UTILITY CONNECTION PERMIT
l `�'N E S��
1. White File pE�IT NO . /�
2. Pink City � 2 'j / �/Z
3. Yellow Applicant ✓ V
lease e or ' t and si at bottom
ADDRESS ZONING (o�ce use)
� �52 ����„�.�--�-� ( �-a.�--P
LEGAL DESCRIPTION (office use onty)
LOT BLOCK ADDITION PID
OWNER � Q,r l l� V�x. q �
(Name) 1 " � (Phone) L5Z '�`� �( � � � �O Co ?
(Address) 1 � � Z �,` � i ...�. � � c� `�t' �
BiJII,DER
(Company Name) � f C� � � o �'"�- � S (Phone) �P � - 3 `Z (o ' (o �7 Z R'
(Contact Name) i3 � � C �o� l G v� (Phone) � � - 3`�'4 < <v `Z ZR
�ada��s> 2 3 Iv b� v-� �...,... �,-a �..
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection I
CODE: ❑I.R.C. ❑I.B.C. �Misc: � W ` �' �'� � - 1 l � �� �
Type of Const�uction: I II III IV V A B �� ��
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE S
Division: 1 2 3 4 5 (excluding la�W)
I hereby certify that I have fumished informadon on Wis application which is to the best of my Irnowledge true and corred. I also certify that I am the owner or authorized agent for the
above-mentioned property and that all wnstruction will confmm to all existing state and local laws and will proceed in accordance with sub[nitted plans. I am aware that t6e building
otTicial can revoke this permit for just cause. Furtherruore, I hereby agree that the city oH'icial or a designee may enter upon the property to perform needed inspections.
X ' �^-�'------� 2 0 2�"7 y S z- � Z..
� Signature Contractor's License No. ate
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 8c Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $
T6is Application Bernmes Your Building Permit When Approved Paid R ' t No.
Date B
Buildin Official Date
'I7�is is to certity that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. T7�is documrnt
when signed by the City Planner constimtes a temporary Certificate of Zoning compliance and apows rnnstruction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Daze Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, faa (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372