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(i.--PR-i CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 5- Z?.. 4-
AND UTILITY CONNECTION PERMIT
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kfHNESOo* I. White File
2. pink City PERMIT NO. ¢34--
/ `
3 Yellow Applicant `
(Please type or print and sign at bottom)
ADDRESS pp ZONING(office use)
I LIdodL 1,00 ft IJ T�'rcr rcikc
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
BUILDER
(Company Name) al-t-.4)1 reO , (Phone)
(Contact Name) Skv .
`� (Phone)
(Address) 44(,-&A) "R( lam) �5C.Iwy^U l'tAt
TYPE OF WORK ❑New Construction ODeck ['Porch ❑Re-Roofing ❑Re-Siding ['Lower Level Finish ❑Fireplace
['Addition ['Alteration ❑Utility Connection �(�� y�
CODE: ❑I.R.C. ❑I.B.C. omisc.
UG`l P't j
. .
Type of Cons ction: I II HI IV V A B PROJECT CO T/VALUE $
Occupancy Gro p: ABE F HI MR SU
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I a e 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-mentioned pro ci 'and that all construction 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 p:- it for just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x • ,1z7/ 1LI
Signature Contractor's License No. ate
1
Permit Valuation _ .' Park Support Fee # $
Permit Fee S 3 b$ =-Si -...___ar SAC
Plan Check Fee (1 v' `�� .t 0 Water Meter Size 5/8"; I"; $
State Surcharge $ I (j Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee Other $ `' 7..,.
Gas Fireplace Permit Fee $ TOTAL DUE — —
_ �`' ��.
This Application Becomes Your Building Permit When Approved Paid """4"
Re apt No.
Date 5.
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