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oF pRJp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
., � AND UTILITY CONNECTION PERMIT I O.(�- I I
U �j
'1►j I. Whire File
z � ; � k � PERMIT NO. �' ��� C��
3 veu�w Applicanl 7
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Please or rint and si at bottom
ADDRESS ZOIVING (otFice use)
�a Z `�--� � 1/J d� � D �.�C_:1<-- TQ- � �i
LEGAL DESCRIPTION (office use onty)
LOT BLOCK ADDITION PID
OWNER OM � S 1�fL�-
(Name) �' 7 (Phone)
(Address) � � �1 a o D � (� ��- �Z- � �
BUII..DER �` /�,�.��,
(Company Name) ��T���� � v , � u � � �" (Phone)
(Contact Name) � �� S �� � (Phone) b � Z- 2� S � � � �
(Address) �` �.3. � �o («' � � � � �� � � ��
TYPE OF VVORK ❑ New Construction ❑Deck ❑Porch �Re•Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Conn non
CODE: ❑I.R.C. ❑I.B.C. � Misc.
Type of Construction: I II III N V A B pROJECT COST/VALLTE $ ���'�
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby cert that 1 have (umished mformation on this application which is to the best of my knuwlcdge true and correct. 1 also certify that 1 am the owner ur authonud agent for the
abuve-menn d property and that all construction wi11 conform ro ali existing state and local laws and wili proceed in accordance with submitted plans. I am aware that the buildmg
official can re ke this permit for just cause. Furthe , I hereby agree that the city official or a designee may enter apon the property to perform ne ded i pecno .
X �2.�Q �3�1�2.3� �(7 l � I
Contractor's License No. 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 Re i t NO.
Date /
Buildi�sa Ufticiat Date
Th�s �s ro certify that the requcst in the above applicahon and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as rcqucsted. Th�s document
when signed by the City Pianner consumtcs a remporary Certificate of Zoning compliance and allows cunsh'uction to commence. Befure �xcupancy, a Ceruficate uf Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372