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�F 'PR I �� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
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� �; �� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE � � s � Z
�....__..�L........... �"' AND UTILITY CONNECTION PERMIT
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1. White File pERMIT NO.
2. Pink City � Z I�� ¢
3. Yellow Applicanl
lease or ' t and si at bottom
ADDRESS ZONING (oe'ice use)
I'� � ti S ��-�L�� ��. � � � . SC
LEGAL DESCRIPTION (ott'ice use only)
LOT BLOCK ADDTTION PID
�� EB � � � C—C � � S � 1.� (Phone) �O I Z — 3 � 3 — �. I � O
(Address) l�� �� �V ox 1� S E '� � b 2 �� • J� 3 �Z
BUII.,DER �p l
(Company Name) S � b � L �-2� ��`�"DR-�'�-'� . �.�- (Phone) (o � �� � 3� — I �� �
(Contact Name) �Ug— C512— 1�� (Phone) �S �-3D3 --� � �7'�V
(Address) 3 SS 1°t _�!��.� �.. O � P,-�£.� 1J -�"� � Z�
TYPE OF WORK ❑ New Construction ❑Deck ❑Pomh �e-Roofing ❑Re-Siding �Lower Level Finish ❑ Fireplace
�Addirion ❑Alteration �Utility Conn ion
CODE: �I.R.C. ❑I.B.C. ❑ Misc:
Type of Consriuction: I II III IV V A B � �)�Y a Q'�
Occupancy Gronp: A B E F H I M R S U PROJECT COST/VALUE S_� O
Division: 1 2 3 4 5 (excluding land)
I hereby ceitify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above-mentioned property and that all rnnshuction witl conform to all existlng state and local laws and will proceed in accordance with submitted plans. I am aware that the building
offi ' an revoke this ' or just cause. Furthermom, I hereby agree that the city official or a designee may rnter upon the property to perform needed iuspections.
x ��� � � '� �l �- Z
Signature Contractor's License No. Date
Permit Valuarion 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 $ TOTAL DUE $
Tl�is ApplicaHon Becomes Yonr Building Permit When Approved P3id R' t No.
Date dU ,l�i . /Z B
Buildin Official Date
TLis is to certify that the request in the above application and accompanying documrnts is in accordana with the City Zoning Ordinance and may proceed as requested. 1'his document
when signed by the City Planna consdtuces a cemporary Certificate of Zoning rnmpliance and allows construction to commence. Befon occupancy, a Certificate of Occupancy must be
issued.
Planning Diroctor Date Specisl Contitions, if any
24 hour noHce tor all fpspecHons (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372