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o4 PRIo,P CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
4/14'NESO'1P L White File
2. pink City PERMIT NO. 1D 5 I 3
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
3y5- 9 S pRve-c.._ l n,, L s-
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
(Name) z " .l L' C� j (Phone) 1 2– (0.– GDS SG
(Address) 3 L 5 ) S 9{4,,n,< --r-,,,L., 5(.AJ
BUILDER
(Company Name) /� (Phone) CO 1 3 — ?0 1 O.26 8
(Contact Name) Pm,,.-e..1 14 0. - H-At-N i V �` (Phone)
(Address)
TYPE OF WORK ❑New Construction ❑Deck ['Porch [ 2.e-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace
['Addition ['Alteration ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑Misc. F.Le1NA44— S;.11-1<11:01.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ J
Occupancy Group: ABE F HI MR SU
Division: 1 2 3 4 5 (excluding land)
1
I he ehw.cert'' 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
ove-mention 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
off can rev e this permit for just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X
Signature Contractor's License No. Date
Permit Valuation ` Park Support Fee # $
Permit Fee $ Z5 ' SAC # $
Plan Check Fee $ ' .2-5.
Water Meter Size 5/8"; 1"; $
cr)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 $ ,LIG
Thisi.lic. ioi 'eco> Your Building PermitWhe App ved Paid 4 .Z�/ Receipt No. 7/
iilik Date �s /ie) By /20
B A ii D to
This is to certify that the reques - iove 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