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oF PR��� CITY OF PRIOR LAKE BUILDING PERMXT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �� 7 ��,
.. x AND UTILITY CONNECTION PERMIT
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���'NE80'C�'' i. wn��e F�ir pERMIT NO .
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+ Yellow Applitant �
Please or rint and si at bottom
ADDRESS ��--- ZOI�TING (oF1'�ce �se�
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LEGAL DESCRIPTION (of�'ice use oniy}
LOT BLOCK ADDITION PID
OWNER i - _,
(Name} C V�i�(1�. c� V�- (Phone) ��2 - 2- �2 � 66� 6
(Address) S� l � S� o � v` `� � o�l S
BITILDER "��'"
(Company Name) ��0.�-�v�UW� �Ur�(� S (Phone) 61Z'q IQ. 3 22 d
(Contact Name) S.e_ �1.. � c�.n G � (Phone)
(Address) 3 2 �( N" �� g�,p�.L.
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roo6ng ❑Re-Siding ❑Lower Levei Finish ❑ Firepiace
❑Addition QAlteration ❑Udlity Connection
CODE: ❑I.R.C. ❑I.B.C. � Misc.
Type of Constxuction: I II III IV V A B PROJECT COST/VALUE �
Occupancy Group: A B E F H I M R S U (exciuding land)
Division: 1 2 3 4 5
I hereby cenify that [ have fumished i�formation on this app(ication which is to the best of my knowledge true and correct I also certify thac ! am the owner or authonzed agent for the
alwve-menhoned property and that all cnnstruction will conform to atl exisung state and local laws and will proceed in accordancr with submitted plans. I am aware ihat the buiidmg
ufficial can revok is prrmi r just c ermore. I hereby agree that the c�ry officia! or a designee may enter upon the property to pc��form necded intipcctions.
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Signature Contractor's License No. Date
Permit a uation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5I8"; 1"; $
5tate Surcharge $ Pressure Reducer $
Penalty $ Sewer/Water Cannection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $
This Application Becomes Your Building Permit Whrn Approved Paid ei t I�TO. �i U
Date � �
Buildin � 011icial D�te i
Th�s u to certify that the requcst in the abuve applicannn and accumpanying documents is in accordance with the City Zoning Ordinance and may proceed a.i requcsted. This document
when signrd by the City PLinner cunstuutcs a temporary Certificare vf Zoning comptiance and allows constsuction to commence. Before <xcupancy, a Cerhticate tif Occupancy must be
issucd.
Planning DirecWr Date Special Conditions, if any
24 hour noticc for all inspections (952) d47-985p, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372