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oF PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE � �, 7��
.. x AND UTILITY CONNECTION PERMIT
U �
��NHggO�� I. White File '7
Z �;�, � PERMIT NO. `�,���,
3 Yellow Applicant
Please or riat and si at bottom)
ADDRESS G ,I� ��� �� � G (office use)
y� r � Crl c�`a�l-� �e., N�J. , a�' L��, �
LEGAL DESCRIPTION (of�'ice use only)
LOT BLOCK ADDITION PID
OWNER 1 ,(� p � / c �/
(Name) �o�v'�V�, �iV' I C� 1" 11��1 sd 1� (Phone) t� S( � 3 ��
(Address) 3 W��(� S G,S ✓��a�(" � �553�
BiJII,DER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Conswction ❑Deck ❑Porch �e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition �Alteration ❑Urility Connection
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 hc7eby certi'ty that I have fiimished mformation on this application which is ro the best of my knuwiedge tnie and correct. I alsu certify that I am the uwner or authonzed agent for the
above-mennoned properry and that all cunsnuctio onform ro all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
ufficial can revoke t' r just c se. ermore, I hereby agree that the city official or a designee may enter upon the property to perform necded i spcchons.
X a� ��.
Signamre Contractor's License No. Dace
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 DiJE $
This Application Becomes Your Building Permit When Approved P1id — R 1 t No.
Date .
Buildim� Utlicial Date
Th�s �s to certify that the requcst in the above applicat�on and accumpanying documents is in accordance with the City Zoning Ordinance and may proceed as rcqucsted. Th�s ducument
when signed by the City Planner constitutes a rempurary Certificate of Zoning compliance and allows const�vction to commence. Before uccupancy, a Ccruficatc uf Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9850, fxx (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372