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�� PR �'�' CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
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� i �� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
"� i__ �',, `�' AND UTILITY CONNECTION PERMIT
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1. White File pERMIT NO . �
2. Pink Ciry f�� `D .0 D
3. Yellow Applicant V
lease or rint and si at bottom
ADDRESS ZONING (ott'ice use)
1 �� �� S �� Tl��i. i l
LEGAL DESCRIPTION (off'ice use onty)
LOT BLOCK ADDTTION PID
OWNER g
(Name) �CL�'� l��i�.- �� ���U�--�'� (Phone) � SZ-'���� �" ��� �
cAaa��s� i�-t Y s (..� T�. i
BUII,DER I _ r ,� �Sl IO l� (�S' �.�� O
(Company Name) �� 1 T E��C`�! l Ol'S (Phone)
(ContactName) �v�. �/ P�1�- (Phone) (oS(��L�D`50
(Address) 15 ( - �..0 S S � -e U (t�- � 5S3-D
TYPE OF WORK. ❑ New Construction ❑Deck �Porch �Ce-Roofing ❑Re-Siding OLower Level Finish ❑ Fireplace
�Addition DAlteration [�Utility Connection
CODE: []I.R.C. �I.B.C. ❑ Misc:
Type of Constcuction: I II III IV V A B � 3 ���
Occupancy Gronp: A� E F H I M R S U PROJECT COST/YALUE S.�
Division: 1 2 3 4 5 (exciuding land)
I hereby ceitify that I haYe furnished information on this application which is to the best of my knowtedge uve and correct. I aLso certify that I azn the owner or authoxized agent for the
above-mendoned property d that coastruclion will mnform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official 1� dvs it r' cause. Fhrthermare, I hereby agree that the city ofRcial rnr a designee may eprer upon the property to perfarm ctio .
X ��/� ' j�!'� � b °��1��� �
ture 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/�Vater 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 $ 7
Tdis Appllcation Becomes Your Building Permit When Approved Paid ReCei
Date B
Buitdi Oi�icial Date
This is to certify thax the request in the above applicadon and acmmpanying documents is in accordance with the City Zoning 0�'dinance and may proceed as recluested. 1'his document
whea signed by the City Plaana consdtutes a temporary Certificate of Zoning rnmpliance and allows construction to commence. Before occupancy, a Certificaze of Occupancy must be
isstted:
Planning Airector Date Special Conditions, if anY
24 hour notice [or all inspections (952) 447-9850, faa (952) 447-4245
4646 Dakota Street SE., Prior Lake, Minnesota 55372
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