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o � PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE / s lZ y ��,.
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AND UTILITY CONNECTION PERMIT 4 �
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��hNBSO�� I. whi�e File / �
Z �;�� � PERMIT NO. / I -y
3 Yellow Applicant / �� � d �
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ADDRESS� ,.� � � �-�',--�` � .- •• -- / ZONING(uf�ceuse)
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
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(Name) i✓; '�.�''��--� � Phone
(Address) �� / � �`�� �� /�/!�!J L� � ( � �� �/
BUILDER r � d�i�C _ ��,�� ., C./ C�ICi — S' j S .
(Company Name) �:' " � � � ' >--� �%� � �� �� U��7� � �' � (Phone) ,
(Contact Name) , '' y� , C.>/L ,� .. � ���— (Phone) �� Z' � � W ' -,�.� -� �
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Address ; 1 � �
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TYPE OF WORK ❑ New Construction ❑Deck ❑Porch � Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Urility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc. , �.
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Type of Construction: I II III IV V A B pROJECT COST/ VALUE $ ,..� �� t/
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby ce . ify that I have fiimished informatio� un this application which is to the best of my knowledge true and correct. 1 also certify that I am the uwner or authoriud agent for the
abuve-men ioned property and that aL corsstruction will conform to all existing state and local laws and will proceed in accordance with submitted plans. 1 am aware that the building
ufficial ca revoke this pe t for j cause. Furthermore, I hereby agree that the city officia �r a designee may e ter upon the property to perform needed spectio s.
X � > �� -� ��: �>�=7 �� y�� � i � � ��-
� anire ,- Contractor's License No. ate
Perr�it 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 $
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This Application Becomes Your Building Permit When Approved Paid 1 t NO.
Date
BuilJin�� (�fticial Date
This �s to certify that the requcst in the abuve applicat�on and accompanying documents is in accordance with the Ciry Zoning Ordinance and may proceed as requcsted. This document
when signed by the Ciry Planner constuums a temporary Certificate uf Zoning comptiance and allows construction m commence. Beforr uccupancy, a Cernficate uP Occupancy must be
iswcd
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9R50, fxx (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372