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,,��%^-��� CITY OF PRIOR LAKE BUII.,DING PERMIT, ��r 75 Date Rec'd
�; � �� x TEMPORARY CERTI� OF ZONING COMPLIANCE
"'� ' `�' AND UTILITY CONNECTION PERMIT
�
� E S ��
l. White FiPP pE�T NO. /�� l� 3�
2. Pink City
3. Yellow A licant `
(Please or ' t and si at bottom
ADDRESS , ZONING (o��e use)
c�� � � Ct�woc�� C � �Cl-e,
LEGAL DESCRIPTION (oifice use only)
LOT BLOCK ADDITION pID
OWNER � Q,
(Name) v�n P� I f� (Phone) _�J � ' < < CU �' ��P V
(Address) � � ! � Q �iL�' �'� � % �' l � � !�`� c� J �
BUII,DER
(Company Name) �/I'?') _�!I?(�' 0 �� 1'�(� (Phone) C� �! • �i� 7 'o?�C �(p
(Contact Name) l�l N (Phone)
(Address) d r� �� U � �ea
TYPE OF WORK ❑ New Construcrion �peck ❑Porch ❑Re-Roofing e-Siding QLower Level Finish p �"' •
�Addition DAlteration ❑Utility Connection
GODE: �I.RC. DI.B.C. ❑ Misc:
Type of ConsUcnction: I II III IV V A B
Ocwpancy Gronp: A B E F H I M R S U PROJECT COST/VALUE $ l�i �UD • C�
Division: 1 Z 3 4 5 (eaecluding land)
I hereby certify that I have fumished information on this application which is to the best of my lmowledge t:ue and correct. I also certify that I am the owner or authorized agent for the
above-mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am awaze that the building
official can revoke tus petmit foY just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x _ �/�%� ���� � � �� �' •o?c3 � //
Signature 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 #p $
Mechanical Pern�it Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ p��. $
Gas Fireplace Permit Fee $ TOTAL DUE $
This Application Becomes Yo�a Building Permit When Approved Paid R ei t NO. 6
Date
Buildin Official Date
This is to certify that the request in the above application and accompanying documents is in acmrdance with the City Zoning Ordinance and may proceed as requested. This document
when signed by [he Ciry Planner rnnsritutes a temporary Certificate of Zoning compliance and allows coastruction to commence, Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Dare Special Conditions, if any
24 hour nofice for atl inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior I.ake, Minnesota 55372