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of PRI CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
U
I AND UTILITY CONNECTION PERMIT
III 4 . 4 vN ESO ; . White C „Y A PERMIT NO. , f . ! F
3 Yellow Applicant
(Please type or print and sign at bottom)
x' ADDRESS ZONING (of use)'
(... 2: n7 a L,,\,, 4 ,./1 s,,,
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
A
OWNEit A-- C_211 -L-1 2 - 1S
(Name) L 1 ^4� (Phone)
(Address) 4%-k _*,'S 014(..- 0 Uf``-014(..— ' v � C �, r Lex1-- -e
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ['Deck ❑Porch ❑Re- Roofing Re- Siding ['Lower Level Finish ❑ Fireplace
DAddition ❑Alteration ❑Utility Connection / J '
CODE: ]I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V AB PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
1 hereby certify th t 1 have furnished 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 -me one roperty and that all roan will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official c e this permit for l ause Furth more, 1 hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
' 1 X 1- Date
Signature Contractor's License No.
Permit Valuation 'Z y Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8”; 1 "; $
State Surcharge $ S _ 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 Ap ' :comes Your Building'Permit Wh Appr' ved Paid - 7 " / Recei. t No. ,, ,- 2 '7
J . do B I Date B cgij
rr_ 0 l
Bt dine Officio hate
•
This is to certify that the roqucsT the e 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