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�� �' � CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� `� AND UTILITY CONNECTION PERMIT
�
r hN E s°� /�L �
l. Wltite F0e PERMIT NO . // �
2. Pink City
3. Yellow Applica�t
CBSC OI 8� � SY LOL[011l
ADDRESS ZONING �o�ce »se�
� � Z � ��C �H
LEGAL DESCRIPTION (ofl'ice use only)
LOT BLOCK ADDTTION PID
OwNER C U' ��� j) F/'� hone) l� l Z �l''176 S3
(Name) ��F L (P
�Aa�s� /5 Z. � 3 t� � 1. v S �t- �� w►�- �
BUII.DER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WO� ❑ New Conshvcfion �Deck OPorch �te Roofing QRe-Siding []Lowa' Level Finish ❑ Fireplace
❑Addilion �Aiteration ❑Utility Connection
CODE: []I.B.C. �I.B.C. ❑ Misc:
T�pe of Cons�uction I II IQ IV V A B
Occupancy Group: A B E F H I M B S U PROJECT COST/VALUE S
Division: 1 2 3 4 5 (excloding la�d)
I haeby certlty tbat I have flunished infocmaaon � this appflcation which is to the best of my Imorvvkdge ave and corred. I also ceRity that I am the owna or anthaiud aa�eent ihr tl►e
above-m ' and at all oaoata�ion will ao�faam ro all existiag state aad local laws and will proceed in a000�dance witb submitoed plans. I am aware that the buildtug
offidal ' r jasc cauae. Pri�thamore, I he�eby aBree that the city �CCiat ar a�ee may �oer upon I�e property to per6orm aeeded inspe�.�daas.
X
Signature Contractor's License No. Date
Permit Valuation Pazk Support Fee # S
Permit Fee $ SAC # S
Plan Check Fee $ Water Meter Size 5/8"; 1"; S
sc�c� s�t,� a rre�u� xea� a
penatty $ Sewer/Water Connection Fee # S
Plumbing Pernrit Fce $ Water Tower Fee # $
Mechanical Petmit Fee $ Builder's Deposit S
Sewer & Water Permit Fce S Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ ,�
T6is Applic�adon Beco�s Yoa� Bm7dios Petmit When Appnoved Paid Recei N " 7
Date B
Buit ' official Dare
This is to a�fy that the mquest in the above appticadan and aocmupanying docoment� is in amordana with ffie City Z�ing Ordinance and may pmoeed as request�. TLia docament
when sigaed by the City Planna 000satutes a oemporaty CerdBtate of Zoning oompliaaa and allows construdion Go commence. Before oocupancy, a CeitiHcate of Oantpancy mnst be
issued.
planning I)irxtor I�te Spaaal Condi6ions, if ffiy
24 hoar eodce For all inspecdoat (952) 447-9850, 6z (952) 447-4245
4646 Dak�a Street SE., Prior I.ake, Minaesofa 55372