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oF QRt CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
�, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT ��y �� Z
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♦��'xeso�cr �. Wh,�e F;�e PERMIT NO. �� /.3 ���
2. Pink City
3 Yellow Applicant
Pkase or 'm and si at bottom
ADDRESS ZONING (ott'xe use>
� � s j .
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
owr�R � � �'sa - YY7- 3�.0 3
(Na:�ne) r� Phone)
(Address)
BITILDER ,�f �
(�ompany Name) �J � � J l.v c— (Phone) �3'�'" �6 "' 7�1t� �
_�—
(Contact Name) � (Phone)
(Address) '��z D � J"l� �`1 o v !�?�/
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition �Alteration ❑Utitity Connection
CODE: ❑I.R.C. ❑I.B.C. � Misc.
Type of Constiuction: I II III N V A B
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE S
(exciuding land)
Division: 1 2 3 4 5
! hereby ce' at [ have fumished informaf this appiication which is to the best uf my knowlcdge true and correct. f also cernfy that I am the uwner or authorized agent for thc
above- none roperty and that aii cu u' n wiU conform ro all exuting state and local laws and wili proceed in accordance with submittcd pians. [ am awarc that the buiidmg
uffici can re e this pecmit fo st ca urthermore ereb agree that ehe dry official or a designee may enrer upon the property to perform necdcd mspcctions.
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x � �e2c�r�g�� ��� 7 ��
Signature Conaactor's License Na 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 # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $
Tiuis Appiicadon Becomes Your Buiiding Perntit When Approved Paid ReC t No. �
Date , i Z B
Buiidine Utiici�l Date
7'hu is to certify that the requcst in the abovr applicahon and accompanying documenis is in accordance with the Ciry Z.�ming Ordinance and may pr�ceed ac requcsted. This di�cument
when signed by the City Planner conshtutes a tempurary Certificate of Zoning compliance and allows construction to commence. Before �xcupancy, a Ccruficate ��f Occupancy must be
issucd
Planning Director Date Special Condidons, if any
24 hour notice for ali inspections (9S2) 447A8S0, fax (952) 447-424i
4646 Dakota Street Prior Lake, MN 55372