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®F PRio" CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIAN
.. AND UTILITY CONNECTION PERMIT
v � R
Iff"A'NESo"tP I. white City
Pink Cit
PERMIT NO. I rJ-.,_
2.
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
5-qo�, Carc�►'hal ��� �r� 0 toLoke M N X537
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PIDo'
OWNERI /
(NLame) G U 1 SG h v/ Y f (Phone) `a�
(Address) G V14
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace
❑Addition ❑Alteration []Utility Connection
CODE: ❑I.R.C. ❑I.B.C. LMisc.
Type of Construction: I H III TV V A B
PROJECT COST/VALUE
Occupancy Group: A B E F H I M R S U $
Division: 1 2 3 4 5 (excluding land)
1 hereby certify that I have furnished informof on 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-mention d property and that co ruction will con for to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can r oke this hermit for j t ca . Furthermore,I by agree that the city official or a designee may enter upon the property to perform necded}dspectt Ons..
/ Signature Contractor's License No. Da;e
V Permit Valuation Park Support Fee # $
v 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 Recei t
Date B
Building Official Date
This is to 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
wbeir si red b-v'fke City Planner constitute porary Certificate of Zoning compliance and allows constriction 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,MIST 55372
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