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oF PR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE - j' /�, I Z
.. x AND UTILITY CONNECTION PERMIT
� �
�►iNNeso��' L Whice File pERMIT NO .
z. r��G c�y �l.
3 Yellow Applicam
Please or rint and si at bottom)
ADDRESS , - ZONING (uFlFice use)
:� :� �' � C�' � `--.l=' f7�'iL �'� �i°� - r - � `
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER ^
(Name) 1 ex '/ � n B /� (Phone)
(Address)
BUII,DER
(Company Name) A �� o � C�,. S,� � uc �% u� (Phone) ����5 � 76 7'� 6 70�
(Contact Name) /1� %s .�/e �:.�c!l-- (Phone) ('Q� Z - 7/O - �O(oS -
(Address) 3'7 S'7 15/ ��G L,i/ � v o�e ,Q,� 1 s
TYPE OF WORI� ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Urility Conn ction
CODE: ❑I.R.C. ❑I.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 (excluding land)
Division: 1 2 3 4 5
! hereby certify that I have fumished information un this application which is to the best of my knuwlcdge true and correct. I also ceitify that I am the owncr or authonzcd agcnt for the
above-mennoned proprrty and that all cunstruction will conform to all existing stare and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
official can revoke this permi forjust use. Funhermore, I hereby agree that the city official or a designee may enter upon the property to perform necded mspectiuns.
X � � E��l �3�i� -�-/�- ao��-
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 Yoar Building Permit Whrn Approved Paid � ecei t NO.
Date �--
Buildin � Utlicial Date
This �s to certify that thc rcqucst in the above applicauon and accompanying documents is in accordance with thc Ciry Zoning Ordinance and may prnceed as requcsted. Thu document
when signed by the Ciry Planner consnmtes a temporary Certificate of Zon�ng compliance and allows construction to commence. Before occupancy, a Ceruficate uf Occupancy must be
issued
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372