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o � PRJp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT ��� 7. � Z
U �
�ij �. Wh;,e File pERMiT NO. ��
2. Pink City
3 Yellow Applicant
Ple r rint and si at bottom
DDRESS '� ZOI�TING (of�c� �se)
�yq� �.�J t `LOw -
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
O R
ame �ICN y�� i ' {�.l.l`� �C'- Qr' CT1�0�._ (Phone) �-�� -3g5-�S��
(Address) ,,,�,.
BUII, �
ompany Nam �k L�T ILO � � � Phone �10 ' 3g`/' eZ 8� �
ntact Nam ) �„ 'T"�U� �_T��l,.�4�a (Phone)
( dress� I B' �o (� l,T S� S T�' v2 f�
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch [�Re-Roofing e-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ,�Misc. C.�! t �..t� ct�s
Type of Constiuction: I II III IV V A B pROJECT COST/VALUE $ 3�
Occupancy Group: A B E F H I M R S U ���
Division: 1 2 3 4 5 (excluding land)
1 hereby certify that I have fUmished information on this application which is to the best of my knowlcdge true and correct. I also certify that I am the owner or authunzed agent for the
abuve-menhoned property and that all cunstruction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
offici oke this permit for just cause Furt ore, l hereby agree that the ciry official or a designee may enter upon the property to perform necded mspectiuns.
X �C. 63 -I -
�gna re ontractor's License 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 $
Gas Fireplace Permit Fee $ TOTAL DIJE $ -
This Application Becomes Your Building Permit When Approved Paid Rec � t No.
Date � .l2_.-- B
Buildine Utticial Date
Th�s u to certify that thc rcqucst in the above applicauon and accompanying documents is in accordance with thc Ciry Zoning Ordinance and may proceed as requcsted. This ducument
when signed by the City Planner consatutes a tempurary Certificate uf Zoning complianec and allows construction tu commence. Befure uccupancy, a Cert�ticate of Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9AS(1, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372