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oF PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, � TEMPORARY CERTTFICATE OF ZONING COMPLIANCE ���
� � AND UTILITY CONNECTION PERMIT � �'
U �
M��'NESa�P I. White File
2. Pink City PERMIT NO . � O 0/1�
3 Yellow Applicant ��
r rint and si at bottom)
ADDRES ZONING (oefice use)
� 1� 1 ►� �T s�
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
, OWNE -
(Naiii� �-� �S (Phone) 2 yya '�y
(Address)
UII.,DER
(Co any (Phone)
(Co c Name) (Phone)
(Address)'�.
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Conn ti
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III N V A B pROJECT COST/VALUE $
Occupancy Group: A B E F H I M R S U
Division: 1 2 3 4 5 (excluding land)
I hereby ceRify at I have fi�rnished information on this application which is to the best of my knowledge true and correct. I also certify that 1 am the owner or authorized agent for the
above-mentio d pro d 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
official can e t s it for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property ro perform necded inspecnons.
X
Signature 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 `f R t t NO. �
Date
Buildim� Otlicial Date
This is to certify that thc request in the above application and accompanying documents is in accordance with the Ciry Zoning Ordinance and may proceed as requestcd. This d�xument
when signed by the Ciry Planner consututcs a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Cettificate 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