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oF PR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �� ����
� � AND UTILITY CONNECTION PERMIT
�
��n'NE5 2 P�'�e ��Y ( PERMIT NO. � ^ l��yy�
3 Yeilow Appliwm �
Please or rint and si at bottom)
ADDRESS L• ���� � e, �� ZONING (ot�'ice use)
� �� /^, e �
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER / /
(Name) ��t (Phone) �� �G "' ��7
(Address)
BUII,DER y � - �� ��
(Company Name)�,�� ��Zf (Phone) 6�
(Contact Name) I� � (Phone)
(Address) 71 �� ,� �` �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �]Re-Roofing ❑Re-Siding ❑Lower Levei Finish ❑ Firepiace
�Addition �Alterarion ❑Udiity Connecnon
CODE: [�I.R.C. ❑I.B.C. ./
❑ Misc.
Type of Construction: I II III IV V A B pROJECT COST/VALUE $<��/
Occupancy Group: A B E F H I M R S U
(excluding land)
Division: 1 2 3 4 5
! hcrrby certi(y that I have tumished �nforma[ion on this application which is to the besi of my knowledge aue and conect. I als� certify that i am the e�wner or authonzed agent for thc
above-ment�oned property and that alt construction will conform to all existing state and local laws and will proceed in accordance with submitted ptans. [ am awaze that the buildmg
official can revok his permit for just cause Furthermore, I hereby agree that the city offtcial or a designee may enter upon the propetty to prrform necdcd mspections.
( X �_2�_��� _ << 2 �' � �
tgnature Contractor`s License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Ptan Check 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 $
Gas Fireplace Permit Fee $ TOTAL DUE $'�
This Appiicallon Beco= our Buiiding Petmit Whar Approvtd Pald � Recei t NO. �/
. L �� / `� Date — B
( �
Buiidina Utficial Date
Thts �s to certify that the request in the atwve applicahan and accumpanying documents is in accordance with the City Ziming Ordinance and may proceed ac requcsted. 'fhis document
whcro signed by the City Planner ennstimtes a tem}wrary Certifieate of Zonfng compliance and allows consvuetion to commence. Befure uceupancy, a Cerhficare uf Oecupancy must be
issucd.
Planning Director Date Special Condidons, if any
24 hour noticc for all inspections (952) 447-9850, fax (9S2} 447-424i
4646 Dakota Street Prior Lake, MN 55372