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of PRjp CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
.� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT U
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44Nes00. 1 White File2. PERMIT NOPink City . /s
3
3 YellownkApplicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
(''2o Zi /tVie AM4i.
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID LS -. Lar.v(5 2., 0
OWNER Mt
(Name) ! , G k Ce f,g,C. (Phone)
(Address)
BUILDER
(Company Name) //444.42:3,,,t, 44%.37. ,..Z, -"e , (Phone) &Z.— we.,
(Contact Name) t4 (Phone)
(Address)
TYPE OF WORK El New Construction ['Deck ['Porch Re-Roofing ❑Re-Siding ['Lower Level Finish ❑Fireplace
['Addition ['Alteration GUtility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑Misc.
Type of Construction: I II III IV V A B
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished • rmation on this applicatir,.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 • all construction will conform to'.II existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
offi _can revoke this permit f. : r e. un ermor -re. a• -.- -at the city offic' a designee may enter upon the property to perform needed Inspections.
4IMIMIIIIMIIIr -ri"
a' ii�— Contractor's License No.
401. 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 7s • l 3 R rpt No. 67 7
Date V 2,6,, 41—
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