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0 p �' O R Y OF PRI4R LAKE BUILDING PERMIT, Date Rec'd
� � T�MPORARY CERTIFICATE OF ZONTNG COMPLIANCE
v � AND UTILITY CONNECTYON PERMIT �"'' O '��'"
� ��A'NES��� .
�: Wh��e F;,e pERMIT NO. j ��
. . 2. Piik City "`�
� � � 3. Yellow Applioant G� � �
iease or rint and si at bottom
ADDRESS ZONING iotFi�e use)
�� � �.�z i �
LEGAL DESCRIPTION {office use only)
LOT BLOCK ADDITION PID
OVVI�IER � ,1,, ( ) �� � � 'c �"��,
(Name) C r "�' � ��n n c—[.��''-�Z_. Phone c
(Address) 3C�j�.O �
BUILDER �c� �/�
(Name) (..:.J 4 � (Phone) �D�' ���
(Contact Name) (Phone)
(Address) ��� J �l n �C�. � V� , �
T �YPE OF Vi�t7t'.I'� [7 New Co;istrc,crion ❑I)ec'c ❑Porc�z �,^.e-RooFing �]Re-5iding `
❑Lower Level Finish ❑ Fireplace []Addition (]AIteradon ❑Utility Connection
❑ Misc. PROJECT COST/VALUE (exduding land) �
I hereby certify that I have fumished informa6on on this applica6on which is to the best of my lmowledge true and correct. I also certify that I am the owner or
authorized agent for the above-mentioned properry and that all cons�uction will conform to all existing state and lorallaws and will proceed in accordance with
submitted plans. I am aware that the building official can revoke this permit for just cause. Furthermore, I hereby agree that the city offiCial or a designee may
enter n the property to perform needed irtspections. d
x � ����J� /J� Z� � ��' `�
Signatwe 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 $ City SAC and WAC # $
Plumbing Permit Fee $ Water Tower Fee # $
, Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $
This Appfication Becomes Your _Building Permit Whea Apptoved Pald e 1 t NO.
Date 3l� . �
Building Official Date
This is ro certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed az requated. This documrnt
whett signed by the City Planner consticutes a cemporazy Cestificate of Zoning compliance and allows consuuction to commence. Beiore occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-41f15
16200 Eagle Creek Avenue Prior Lake, MN 55372