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o � rRj CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
.. � AND UTILITY CONNECTION PERMIT �� �'��
U �
4rHTiESO�h 1. White File PERMIT NO )
2. Pink (�ity � l(� 1/ � C�
3 Yellow Applitant
Please or rint and si at bottom
ADDRESS ZONING �o�e��� �Se�
��4�� �� N � �
LEGAL DESCRIPTION (oEt'ice use only}
LOT BLOCK ADDITION PID
OWNER '
(Name) H �' �..' ( � (Phone)
(Address)
BUII,DER
(Company Name) rDCar � Iy► o L/ N (Phone) ��� �ZO �.5 �l3
,
(Contact Name) � fI' tl� (Phone)
(Address) � 7� r,J p� �J �J� 37
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing e-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Aiteration ❑Utility Connection D�� ��
CODE: ❑I.R.C. ❑I.B.C. [] Misc.
� �J IlJpov�s
Type of Construction: I II III N V A B
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $
Division: 1 2 3 4 5
(exciuding land)
1 hereby ecrtify that [ have Cumished information on this applieation which is to che best of my knowiedge nue and conect. i aisu certify thac I am the owner or author�zed agent for the
abuve•ment ne property and that all cunstruction will conform ro att existing state and local laws and will proceed in accordance with submitted ptans. I am aware that the buildmg
uffi � �fhi rmit f st se Furthermore, I hereby agree that the c�ty official or a desigrtee may enter upon the property to pe��form necded mspcctions.
X
r��C./'r3 ���� 1 � /z
Sign re Contractor's License No. Date
Permit Vaivation Park Support Fee # $
Permit Fee $ SAC # $
Pian Check Fee $ Water Meter Size 5/8"; I' ; $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Buiider's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $
This Application Becomes Your Building Perntit When Approved Paid ei t No.
Date D .
Buildin � Utlicial Date
Thu u ta certify that the request in the above applieahon and accumpanying documents is in accurdance with the Ciry Zoning Ordinance and may psotteA as requcsted. Thss document
when signed by the City Plarmer cunst�tutes a tempurary Certificate of Zoning compiiance and allows canstruction to commence. Befure uccupancy, a Ccrhficate of Occupancy must be
issucd.
Platming Director Date SQecial Condidons, if any
24 hour notice for ali inspections (952) 447-985(I, fax (952j 447-4245
4646 Dakota Street Prior Lake, MN 55372