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�j 'P�R I �� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
��,� '�\ `�, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
"`� � ' �`� � `� AND UTILITY CONNECTION PERMIT
�
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I. Whi[c File PERMIT NO .
Z. P;� �; /L - /3Z0
3. Yellow Applicant
lease e or ' t and si at bottam
ADDRESS ZONING (oetice use)
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LEGAL DESCItIPTION (ott'ice use only)
LOT BLOCK ADDITION PID
OWNER ^�,
(Name) / v( Ot v� � D� �j 1 C- (Phone) � S Z ' C f� l� -2 z
(Address) I 7 �I `'� 2. OG�r- r{' �. � -� � r . S � �j ; a.r �--C �� /�i( N � 3 �7
BUII..DER
(Company Name) S6 � G r /1�l i c� a6� � S�'� �v, G. (Phone) � 3 S�'� S7 O Z
(Contact Name) �' � � '�- C� � � -e-�f �5 o r (Phone) s�"'�'�—
(Address) 1 Z� Z g .=r o�l � S�n'� � I �.r k- �� V� �� ►^+. o. /J SS'<-/
TYP� OF WORK ❑ New Construction ❑Deck ❑Porch �Re-Roofing ORe-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition QAlterarion ❑Utiliry Connection
CODE: �I.R.C. �I.B.C. � Misc: � �-��•-'}'
Type of Construction: I II III N V A B
O c c u p a n c y G r o u p: A B E F H I M R S U P R O J E C T C O S T/ V A L U E S Z U� �•�' �
Division: 1 2 3 4 5 (exclnding land)
I hereby certify that I have fumished infocmation on this applicntion which is to the best of my Imowledge true and cornct. I also cntify that I am the owner or authoriud agmt for the
abme-menaoned pmperty and that all construction will conform ro all existing state aud local laws and will proceed in accordaace with submitted plans. I am aware that the buildiag
offiaal can oke pe for juM cause. Flirthermore, I hereby agree that the city official or a desigaee may rnter upon the property ro perform needed inspecti
X ���-� ` u �� 1`7 � Zz.c�� j fl�3O � z
Signature Contractor's License No. Date
Permit Valuarion 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 # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other a
Gas Fireplace Permit Fee $ TOTAL DUE $ �L
This Application Becomes Your Building Pamit Whrn Approved Pazd Z Recei t
Date / B �"
Buildin Official Date
This is to ccrtify that the request in the above applicaaon and accompanying docummts is in accordance with the City Zoning Ordinance and may proceed as requested. This docummt
whrn signed by the City Planner consdtutes a temporary Ce�ti6cate of Zoning campliance and allows construction to commence. Hefore occupancy, a Certificate of Occupancy must be
issued.
Plaoning Director Date Special Conditions, if any
24 hour noNce for sll inspecdons (952) 447-9850, fax (95Z) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 5537Z