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,� / CITY OF PRIOR LAKE BUILDING PERNIIT, Date Rec' d
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERNIIT
r �'NES °
1. File PERMIT NO.
3. Yellow Applicant 7 � r .
(Please type or print and sign at bottom)
ADDRESS r ZONING (office use)
q —18 le 4�(t- —c� TAS1 E.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) 0Jl2.---- (Phone) `ZE 0 2— 440 S OU 1
(Address) Li D i-P�A - yL dl .i -o / --t C 1 . k L , Vl) N 65 * a
BUILDER II II
(Company Name) .._4.A.`Et! .I . _ " (Phone) �p Si -� `t � / - � �
(Contact N a m e ) ` • " I ( P h o n e ) LDS( - 1 g 4 — »- /e 4 Lp
(Address) � I 1 ' ' /' A) S
.
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch te- Roofing DRe-Siding DLower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE; EXILC. DLB.C. ❑ Misc:
Typo Of Construction: I 11 III IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ / 5 , (e 57 '
Division: 1 2 3 4 5 (excluding ian4)'
I hereby certify that I have finished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above - mentioned property and that all constru.. .n will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can r * t . s permit for ' • t cause. ` . ermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
r Si .,.s . ture 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 # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE 0 $ l 1 -7�----
This Application Becomes Your Building Permit When Approved r
PPS Paid '� � l Receipt No. c o S U J
Date ? 2 6 , - /3 By
Building Official Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions, deny
24 hour notice for all inspections (952) 447-9850, fax (952) 447 -4245
1(146 Dakota Street S.E., Prior Lake, Minnesota 55372