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t Pto o ' CITY OF PRIOR LAKE BUILDING PERMIT, L./ Date Rec'd
r TEMPOR ARY CERTIFICATE OF ZONING COMPLIANCE 4 1 ` j AND UTILITY CONNECTION PERMIT "r
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A ZONING (office use)
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LEGAL DESCRIPTION (office use only) '/./ /
LOT BLOCK ADDITION CJ /L s 2C / - - GU Ca . U
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(Name)
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TYPE OF WORK ❑ New Construction ❑Deck DPorch DRe- Roofing ❑ Re-Siding ['Lower Level Finish ❑ Fireplace
DAddition ❑Alteration
❑Utility Connection �[''�l n f r
CODE: R.C. ❑L ❑LB.C. . 1 i sc. `V V 6 11/4too
Type of Construction: I II III IV V AB
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $
Division: 1 2 3 4 5 (excluding land)
I hereby certity that f have h ished 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 , that all cons ion 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 revoke thi . .,;rw for Just cause theimore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections -
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Alrr ' '� L .ntractor's License N. . Date jfiI K//
Permit Valuation 0..) (' Park Support Fee # $
Permit Fee $ SAC ## $
Plan Check Fee $ Water Meter Size 5/8 "; I"; $
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 1 $ TOTAL DUE $ — i
This Application Becomes Your Building Permit When Approved Paid '��" Re . t No. UP ,
Date Aj /IFAIIIIIIMM'
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 Prior Lake, MN 55372