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o � PR��� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ��3 ��
.. � AND UTILITY CONNECTION PERMIT
v �
~j�TNeSO�P !. Whiie File PERMIT NO .
2. Pink fity � �� - �i�! � �
. 3 Yellow Applitant Gl
Please or rint artd si at lrottom)
ADDRESS ZONING c�r���� �Se>
`�l�a f�s � �- �-
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER • *� °—� _ �t,�'
(Name) �j � ���Y (Phone) C �
(Address) �( 7 � C �� S � "�' � ��3'�
BUII,LIER / /� Q / /
(Company Name) .T'�LC ��2.-- Y1 �' / � �" `( -� R � L • �.� (phone) �P l � '� � l � —G S� �
(Contact Name) ?�%�.�1�'l Z- (Phone)
(Address) l G' ��"' f_""�- ss/�" ,.,�.- L.-._ p2�.. !�
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch -Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. DI.B.C. O Misc.
Type of Construction: I II III IV V A B
PROJECT COST/VALUE S
Occupancy Group: A B E F H I M R S U (exciuding land)
Division: 1 Z 3 4 5
I hueby certify that I have fumished infcmmatio� un this application which is ro the best of my knowicdge true and conect I also cet7ify that I am the uwner or authortzed agent for the
above-mentioned property and that aIl construction will conform ro ati exis[ing state and tocai laws and will proceed in accordance wi[h submltted plans. 1 am awaze that the buiiQmg
ufficial can revoke t' etmit fo cause r�more, I hereby agree that the ciry official or a designee may enter upon the property to perform necded mspections.
x --j � ��
--_ Signature Conuactor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Ptan Check Fee $ Water Meter Size S/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 Building Permit When Approved Paid ' Re i t NO.
Date . I Z.,, B
Buildin � Utlicial Date
This u to certify that the requcst in the aUove appticaaon and accumpanying documents is in accordance with the City Zonin�; Ordinance and may prnceed as requcsted. Thrs dixvment
when signed by the City Planner cunshtutes a tempurary Certifieate of 2oning compliance and aAnws canstruetion tu eommence. Before ciccupancy, a Cc�tdicatr of Occupancy must be:
issucd.
Planuing Director Date Special Conditions, if any
24 hour notice tor a!! inspectioos (9S2) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
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