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of PRio CITY OF PRIOR LAKE BUILDING PERMIT
F ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Date Recd
AND UTILITY CONNECTION PERMIT
White Ape I pERMIT NO.%S. _` J
2. Pink City
(Please type or print and sign at bottom) Yellow Applicant
ADDRESS
I ! ZONING(office use)
IO3 0t A r r c� t/-e_ SL
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION
PID
OWNER ,�I�
(Name) /it A .. /'c.-,e (e (Phone)
(Address) l ( 5 C Lr, C SC
BUILDER 11//
(Company Name) Soffit-t--4 ✓ e 1-y-. �74,'lie s .L,./ (Phone)
(Contact Name) r (Phone)
(Address) `� 9 �a� (,tle jas f--v` 1"yv crog�
TYPE OF WORK ❑New Construction ❑Deck ❑Porch kf.e-Roofing ❑Re-Siding ❑Lower Level Finish El Fireplace
❑Addition DUtility Connection
CODE: DI.R.C. DI.B.C. 0 Misc.
Type of Construction: I II III IV V A B
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ �t 000
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I 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-mentioned property 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 this permit for just cal - - . ore,I herebyagter that rhe citYofficial or a designee may enter upon the property to perform needed inspections.
Signature Contractor's License No.
Date
Permit Valuation Park Support Fee #
Permit Fee $ -77t SAC
Plan Check Fee $ Water Meter Size 5/8"; 1";
State Surcharge $ ( Co 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 $ ' � 4 $
TOTAL DUE $ '791 75-
This Application Becomes Your Building Permit When Approved Paid 71:, I Receipt
I No.
7�— '� ByBy
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
4646 Dakota Street Prior Lake,MN 55372