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oF PRI�� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �� Z,�(J
., x AND UTILITY CONNECTION PERMIT
U �
M��'NES��P I. White File pERMIT NO. `� ./ D 0
2. Pink City
.. 3 Yellow Applicant
Please e or rint and si at bottom)
ADDRESS ZONING (o�f'ice use)
`3� O /9�1. �e. Gl , �Z l._. c�
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OW1vER
(Name) (Phone)
(Address)
BUII.,DER � /
(Company Name) �1� � A�,n .� C_-C� rt_. S � -� /l.� � (Phone) /O � " 02 �s 9 ' � � � 3
(Contact Name) /2v/�-o �"' _ (Phone)
(Address) (, QG�f� / 77 G�� �I'� � U � � � $3
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �,Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility 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
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I e' �mished information on this application which is to the best of my knowledge troe and correct. I also certify that I am the owner or authorized agent for the
above-mentioned pr perty nd that all c nstruction 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 revoke 's per it for s se. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform necded inspections.
X ��� �� � 7 � � � /
� Signature Contractor's License No. ate
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 DLTE $
This Applicarion Becomes Your Building Perntit When Approved Paid Re 1 t NO. �o
Date /. , v
Buildin � Ufticial Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the Ciry Planner constitutes a temporary Certi6cate of Zoning compliance and allows construction ro commence. Before occupancy, a Ccrtificate of Occupancy must be
issued,
Planning D'uector Date Special Condidons, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372