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A.ov "io.pr. CITY OF PRIOR LAKE BUILDING PERMIT
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Date Rec u
AND UTILITY CONNECTION PERMIT 7 2'15-
44ivE sO.0
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I. White File
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3PERMIT NO. / 2754_.si: at bottom) 3 Yellow Applicant
ADDRESS 1�,,,/'`�'� � p 1.\.)
i E' l (O ti 1 `y `� ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION
OWNER PID
(Name) ■. 1/ j• I \71)')1 C... Y Y - t^(�� _
(Address) 3 /� �, � (Phone) � Z 2D___________ /:: 5__
a.. i I ' \lel e/0 C h/l) "S.
0. 1
BUILDER
(Company Name)
(Contact Name) (Phone)
(Address) (Phone)
TYPE OF WORK 0 New Construction
�Alterao❑Deck ❑Porch 1''e-Roofing ❑Re-Siding ['Lower Level Finish
['Addition
Addition ❑Utility Conne i.n ❑Fireplace
CODE: DI.R.C. DI.B.C.
❑Misc.
Type of Construction: I II III I V
Occupancy Group: q B V A B
Occupancy
E F H I M R S U PROJECT COST/VALUE
I 2 3 4 $
5 (excluding land)
DiI 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
above-ment'ned grope that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I amt aware
official can e this permit font ause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to erform
or authorized agent for the
X ' that the building
P needed inspections
Signature =----- Y-.s'-- �1^ —
Permit Valuation Date/________
Permit Fee Park Support Fee #
IIIIIIIIImn
Plan Check Fee
111111111111111111 Water Meter Size 5/8"; I"
; IMMINIMMEINENNE
Penalty • Pressure Reducer 1.11111111111111111111
Plumbing Permit Fee Sewer/Water Connection Fee #
IIIIIIIIIIIII
Mechanical Permit Fee Water Tower Fee #
Sewer&Water Permit Fee Builder's Deposit
1111111111111111. 1111....
Gas Fireplace Permit Fee Other
TOTAL DUE .. urawin
This Application Becomes Your Building Permit When Approved ,
Paid
.t No. /` -'-
Date _ Z , s'
Buildiiio Ofoetal ■
Date
iii
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,
issued proceed as requested. This document
P� y,a Certificate of Occupancy must be
Planning Director
Date
24 hour notice for all inspections(952)447-9850 Special Conditions,if any
4646 Dakota Street Prior Lake,MN 55372