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o � PR��� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ` G ,l �
� AND UTILITY CONNECTION PERMIT �' �
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"Mi I. White File PERMIT NO
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3 Yeliow Applicant V
Piease or rint and si at bottom
ADDRESS �'��G"� ����� ��'� �� ZONING (o�►'ice use>
� Y'` C� � H r d N I�� �
LEGAL DESCRIPTION (of�ice use only)
LOT BLOCK ADDITION PID
OWNER „_
(Name) (Phon �..5 d '� �'.���
(Address) 5 ���� � �� /V G
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Consauction ❑Deck ❑Porch e-Roo6ng ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Urility Conn ion
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: 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
(exciuding land)
I hereby certify that [ have fumished information on this application which is to the best of my knuwlcdge troe and corcect. I aiso certify tha[ 1 am the owner �x wthonzed age�t for the
alwve-mentioned p�yw�nd that a(1 construction will confurm to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that tde building
otTiciai ca �his per usc cause. Furthermore I hereby agree that the dry official or a des[gnee may enter upon the property to perform necded mspecf >ns.
g f��� — 7 �
Signature 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/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other S
Gas Fireplace Permit Fee $ TOTAI, DITE $ _
This Appiication Becomes Your Building Permit Whtn Approved P81d Cei t NO.
Date _ !Z B �.
Buiidin � Utlicial Date
This ic to certify that thc requcst in the above applicaunn and accumpanying documents is in accardance with the City ZA�ning Ord'enance and may praceed :vti requ��ted. Th�s ducumrnt
when signed by the City Planner eunsututes a tempuiary Certificate of Zoning compiiance and allows cansuuction tu cammence. Before uecupancy, a Cerhficate of Occupanty must br
iuucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9RSb, fax (952) 447-4245
4b46 Dakota Street Prior Lake, MN 55372
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