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oF eR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE `d� ��, � Z
� � AND UTILITY CONNECTION PERMIT
U �
4 lX NEg �4�' i. Whice File
z � ; �� �„ PERMIT NO. `z� � z�
; Yeilow Applicant
Piease or rint and si at bottom
ADDRESS i ZONING (otTce use�
S�Si c���� ��.
LEGAL DESCRIPTION (oflf'ice use only)
LOT BLOCK ADDITION PID
O a WNER ,�/ �-V� 1/�C,,� �Z S.S � C�� (� - (Phone)
6 ��
(Address) ( �� J � � ��
BUII,DER � � �S ���^� � �1
(Company Name) ' (Phone) v
(Contact Name) �--� � � �eS / (Phone) 76,� ,.S' 7�_` �
(Address) l � �j ��j ��-� � (,� v! ` �� fl
TYPE G1F WORK ❑ New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition []Alterarion ❑Utility Conn ction � �
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B pROJECT COST/ VA.L $ L� 0
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
[ hcreby certify thaz t have fi�mished mformation on this application which is ta the best uf my knowicdge true and correCt. I also certify that t am the vwncr or authonzcd agent for thc
above-ment�oned p operty and that ii construc[ion will conform to ali existing state and local laws and will proceed in accordance with submitted plans. I nm ware that e buiidme
� uffieial can revo is perm f ju t ause hermore, I hcreby agree that the city offici or a desig���er� n th� pexry ro perform necded�pc� ns. �
X C O � c�
Signature Contcactor's License No. Dat
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Redueer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Fermit Fee $ Water Tower Fee # $
Mechanical Permit Fee S Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Firepiace Permit Fee $ TOTAL DLTE $
/
Tltis Application Bernmes Your Buiiding Permit Whea Approved Paid � Re e t No.
Date , � �2� B
Buildin � Ut7icial Dnte
This �s to certify that the requcst in the a(wve applicanon and accumpanying documents is in accordance with the City Zoning Ordinance and may proceed as requated. This ducument
when signed by th� City Planner consurotes a temporary Certifieate of Zoning comptiance and alluws construction tu commence. Befure uccupancy, a C�ruficatr uf Occupancy must be
issucd-
Planning Director Datc Special Conditions, if any
24 bour noticc for alf inspections (952) 447-9850, fax (4S2) 447-4245
4646 Dakota Street Prior Lake, NIN 55372