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o � re� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �� � � � �_
� � AND UTILITY CONNECTION PERMIT
�
�. � Wh„e File pERMIT NO.
z r��� a� �
3 Yellow Applicant
Please e or rint and si at bottom
ADDRESS �, ZONING (otrt use�
�'J� �.� �`�1�� i"7 / /�'C;l G''/�� � �� .
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER ,L,�
(Name) / ( `Q ( �-`�� fi'� ���-�/ (Phone)
(Address)
BUII.,DER y� � {� j��
(Company Name) ��'�� /(�J t t� d�it � `� (Phone) �c�� -��� ` ^��
(Contact Name) �- r' �L°S (Phone) 76 .� .3 �� d� ? �[
(Address) ��j ,f �- c�,� R G✓
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Conn ction
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 (exclnding land)
Division: 1 2 3 4 5
I hereby certify that 1 have fi�mished information on this application which is to the best of my knowledge tnie and correct. I also certify that 1 am the owner or authonzed agent for thc
abuve-menhone prope�ty and that all construction will conform ro ali existing state and local laws and will proceed in accordance with submined plans. I am aware that the buildmg
uff'icial can re e this per or i ctns l'�thermore, lihereby agree that the ttty official or a designee may enter upon the proQecry m perform necded m: ectiu
X /.�G 6'3 �2.�' 2 6' �t / Z.
Signature Cantracror'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 Perrnit Fee $ TOTAL DUE $
This Application Becomes Your Buildii�g Permit When Approved P31d . Re 1 t NO.
Date
Buildim� Ufticial Date
This ts to ceRify that the rcqucst in the alwve applicauon and accompanying documents is in accordance with the City Zuning Ordinancc and may protteA as reqacsud. Thls documcnt
when signed by the Ciry Pianner consnmtes a tempurary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certrticate of Occupancy must be
issued
Planning Director Date Special Conditions, if any
24 hour noticc for aN inspections (952) 447-9850, fax (9S2) 4A7-4245
4646 Dakota Street Prior Lake, MN 55372