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,� / ,1,� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
' ' ! \ \'7 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT Ca - ((- ( Z'
r�'NEso�
1. white File PERMIT NO ( 574....d
2. Pink City Z
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ti ZONING (office use)
/413 /6 Oou5 co ' P 6 64 `C iL 77�
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
O 6 a I" l L `s. l� S 4,\ (Phone)
(Address) L / 3 y ( 9 COj11 li (- �'C C. C"�—L 11,72 /API-
sS"372
BUII,DER
(Company Name) nJ &q..14-1 4T? &J W �" 11 tier/ (Phone)
���L /
7 y
(Contact Name) /)' E (Phone) )- - /1sy -- o/
(Address) f C ) . 4 ) e ' . - ��5 ?c° . AL C Y buCIN /Lt./Am-ice c7 ..1 2-0
TYPE OF WORK ❑ New Construction ❑Deck ['Porch J° 6Roofmg DRe-Siding ❑Lower Level Finish ❑ Fireplace
['Addition ['Alteration ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc:
Type of Construction: I 11 III IV V A B ,, )
Occupancy Group: A B E F III MR S U PROJECT COST /VALUE $_ / CA
Division: 1 2 3 4 5 (excluding land)
at
I hereby c th 1 h info 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- ndoned prop e : and that furnished all constmcti rmation o -
1 conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
offs ' can revoke permit fo .: se. , ore, I hereby agree that the city official or a designee may enter u on the property to perform needed inspections.
: gna e 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 $
This Application Becomes Your Building Permit When Approved Paid i l ., ?I ceipt No. (p(,Q Q( ""
Date t4 .!!. 1 t
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, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372