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oF pRtp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
� �,
'yj� I. White File
2 �;�� �;, PERMIT NO. f�.. ��i� j
� 3 Yellow Applicam
Please e or rint and si at bottom)
ADDRESS � ZONING ������ use�
c,,c�oa� r� <
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWrTER ° �� VI C� �
(Name) � (Phone)
(Address) 3� L 6 �/`� � O� ��� �� 1 �/ �
( II 'L 1�-� �C�o'�2 �7 � �� �/X�' _ (Phone) C is L � �� ��� �
(Contact Name) � � (Phone) 76 �� 3 � ^�d ?�
(Address) 7�C l6 `C �—
TYPE OF WORK � New Construction ❑Deck ❑Porch e•Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑UUliry Conn tion �
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Constiuction: I II III N V A B pROJECT COST ALUE $__�/ �� v
Occupancy Group: A B E F H I M R S U (excluding land)
Division; 1 2 3 4 5
I hereby cettify that I have fiimished mformation on this application which is to the best of my knuwledge tnie and correct. 1 also certify that 1 am the owner or authonud agent for the
abuvo-menAOned p erry and that all c r c'on wil n m ro all existing state and local laws and will proceed in accordance with submitted plans. I am aware hat thc buildmg
official can revo t s permit for just c hermo , reby agree that the city official or�igne� enter u� the property to perform need�cpe ns.
X ,� � ,� �
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 DUE $ ' .�
This Application Becomes Your Building Perntit When Approved Paid j ReCei N.
Date B
BuilJin � Utlicial Date
Th�s �s to certify that the requcst in the above applicanon and accumpanying doc�ments is in accordance with the Ciry Zoning Ordinance and may proceed as requcsted. Th�s ducument
when signed by the Ciry Planner consntutes a temporary Certificate of Zoning compliance and allows construction tu commence. Before uccupancy a Ceit�ficate of Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9RS0, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372