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�� �� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec d
� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" � AND UTILITY CONNECTION PERMIT
�
r �'NES��
1. White File pERMIT NO .
2. Pink City /� ,� /��
3. Yellow Applicant
ease e or rint and si at bottom
ADDRESS ZONING (oflPice use)
(� .�-� t � �6'� �v �� � �� ��
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
owrrER n eL Cv �' sZ -�'l y7- �'11�b
(Name) �T?' � � c%l [ � � (Phone) j
(Address) � �j �7 � L �i�.1 �j � �`�' /VCi'_ p�l [�,/r-Z- �^-� 5���
BUII,DER �(/� � `�� � Civ`/l�i" �J I '7�D - �UC �
(Company Name) � (Phone)
(Contact Name) ��G�S � � (Phone)
(Address) 2 -21 � f ( �� �if/ � � 7� � �v ��. S� /� h-�/ S��U �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition �Alteration �Utility Connection
CODE: ❑I.R.C. ❑I.B.C. '�Misc: '�/��° v'�l � �"`'�� �"'t �j�"'� vla^�`'1S
Type of Coastruction: I II III IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE S 6�76 �
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have fumished information on this applicallon wluch is to the best of my ]mowledge aue and cared. I also certify that I am the owner or authorized agent for the
above-menponed property and that all construction will wnform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware d�at the building
official can revoke permit r just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X ���"6��1? ��-�o-�Z
ture 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 Pernut Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ �''
Tlus Application Becomes Your Building Permit When ApQroved Paid Recei N
Date 0 B
Buildin Official Date
This is to certify that the request in the above application and accompanying docummts is in accordance with the City Zoning Ordinance and may proceed as requested. This documrnt
when signed by the City Planner rnnstitutes a temporary Certi6cate of Zoning compliance and allows mnsdvction to mmmence. Before occupancy, a Certi&cate of Occupancy must be
issued.
Planning Director Date Special Condidona, if any
24 hour notice for all inspections (952) 447-9850, fsx (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372