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oF PR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
U �r
'Irj�, I. Whi�e File
Z �;�, � PERMIT NO. f� ��
3 Yellow Applicant
Please or rint and si at bottom)
ADDRESS ZOIVING (o�ce use)
t 4 � C�- � � . �
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
O aWNER �Ct,t�`� '`� � 41 Cj� ►� (Phone) � D � �� � ��1 ' �C� l �—
�
(Address) � � S �`t �` '� � i•1 4 V
BUII.DER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utiliry Connection
CODE: ❑I.R.C. ❑I.B.C. �`S�� t Z� �� � � �'T
Type of Consm�dion: I II III N V A B pROJECT COST/VALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certi'ty that I have fi�mished �nformation on this application which is ro the best uf my knowledge true and correct. I also certify that 1 am the owncr ur authonzed agent for thc
above-menuoned property and that all construction wil] conform to all existing state and local laws and will proceed in accordance with submittcd plans. I am awaze that the buildmg
ot'ficial can rev�his pe mit r just ca`'se. Furthermare, I hereby agree that the city official or a designee may enter upon the properry to perform necded mspcctions.
X vy;1 3"`�
Signature Contractor's License No. Date
Permit Valuation � r . Park Support Fee # $
Permit Fee $ . . SAC # $
Plan Check Fee $ �(p �Z �" 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 $ 4
.
This plic 'o mes �our Building Pemtit en proved Paid ReCei t NO.
�� �� Date Z B
�
ui dine Uttic�a Da e
This is to cr•rtify thar the requcst in the abuve application and aceompanying documenrs is in accordance with the City Zoning Ordinantt and may proceeA as requested. Th�s ducument
when signed by the Ciry Planner consututes a tempurary Certificate oF Zoning compliance and allows construction to commence. Befure occupancy, a Cerdticate uf Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for a!! inspcctions (9S2) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
DEPARTMENT OF
BUILDING AND INSPECTION
.
SITE ADDRESS ti'� o
TYPE OF WORK � �rZ ` ����- ` ��
USE OF BUILDING
PERMIT NO. �1 ��Z3 DATE ISSUED 3 � z
BUILDER ��`'�� /�/s'o,�✓ PHONE # �('Z�73D^��Z
NOTE: THlS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
FRAMING �,vs��� �,,,�,�,
E=�-�'� 1 c.�4c_
FINAL �� 1�,�,,., I�} S 3l c'z._._
FOR ALL INSPECTIONS (952) 447-9850
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