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o � PR� CTTY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
�, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 1/
� � AND UTILITY CONNECTION PERMIT l 1'���"
U �
~�HNES��C�' ', Wh„` F' Y pERMIT NO. (' �—�
? ���► c��
; Yellow Applican�
Piease or ri»t and si at bottom)
ADDItESS ZONING (o�tsce use)
�-r � � �� �, . - - —�� r �v � P.�- �. �e --�w � � $ ��-
LEGAL DESCRIPTION (oflf'ice use only)
LOT BLOCK ADDITION PID
O aWNER f � a L- �� ' q P (Phone) !�. _� r fU _ g 3 f
(Address)
BUII,DER
(Company Name) �.��i.C..r �C- ��S 1�c.c�-� y � F C( C (Phone) b�<. .� r�- GY Q1
(Contact Name) _ -`� L t- � � "h.« -�-� (Phone)
(Address) a-g - E,-n a,r.� �. S S� 3� o ���. S .�v' Q
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �e;,�toofing ❑Re-Siding ❑Lower Levei Finish ❑ Fireplace
❑Addition �Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. � Misc.
Type of Construction: I II III IV V A B pROJECT COST/VALUE S
Occupancy Group: A B E F H I M R S U
Division: 2 2 3 4 5 (excluding land)
i hereby certify that I have fumished information on this application which is to the best of my knowledge true and correct. I alsu cecnly that 1 am the owner or authi�nzed agent for the
above-ment� ed property and that aii cunstruction wili conform to ali existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
utl'iciai c e ke this it for ust cause Furth rmore, I hereby agree tha[ the ciry official or a designee may enter upon the property to perform necded mspections.
� X ��, �� �� 3 ;r` �f .Y
Signature Contractor's License No. ate
Permit Valuation Park Support Fee # $
Permit Fee $ "7� � S— SAC # $
Plan Cheek 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 S
Gas Fireplace Permit Fee $ TOTAI. DUE $
Titis Appiication Becomes Your Building Petmit When Approved Paid Recei t NO.
Date / - B
_ ��—� _���.
Buildntie Utiiciat Date
This is to certify that the requcst in the above applicahon and accvmpanymg documencs is m accordance with the City ZAming Ordinancr and may proceed ae requ�K[ed. Th�s document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and aAi�ws construction tu commence. Befvre �xcupancy, a C�raficate uf Occupancy must be
issttcd-
Planning Director Date Special Condiaons, if any
24 hour noticc for all inspections (952) 44�A850, fax (952) 447-4245
4646 Dakota Street Prior Iake, MN 55372