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o � PR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE (,� ���
� � AND UTILITY CONNECTION PERMIT 7
�
~��NES��R l. White F+ie PERMIT NO /
2. Pink City
3 Yellow Applicant �� / {' 0
Please or rint and si at bottom
ADDRESS ZONING (o�'ice use>
b �b ��d ` � S�
LEGAL DESCRIPTION (oflFice use only)
LOT BLOCK ADDITION PID
owivEx SZ- � �
��, rG�� t �,� ��o�, �' � N r�
(Address)
BUII,DER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Conswction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Aiteration ❑Udtity Conn ctio
CODE: ❑I.R.C. QI.B.C. ❑ Misc.
Type of Constructionc I II III IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COST/YALLTE S
Division: 1 2 3 4 5
(excluding land)
1 he7eby certify that [ have mis d information un this apptication which is to the best of my know►edge true and correct. [ atso cecti(y thaz I am the owner en authorucd agent for the
above-mentioned property nd t ll n uction will conform ro atl existing state and tocal laws and wiil proceed in accordancr wich submitted ptans. I am aware that the building
ufficiai can revoke this t ju use Fu ermore, 1 hereby agree that the ciry official or a designee may enter upon the property to prrform ne� iatipections.
X ��� (��
Signature Contractor's License Na flate
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; i"; �
State Surcharge $ Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanicai Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DLTE $ C�
.
This Appiication Becomes Your Buitding Perntit Whm Approved paid Re t NO.
Date . ?„ r� B �
Buildin � Otlicial Date
This �s to certify that the requcst in ehe abuve applicauon and accumpanying documents is in accordance with the City Zoning Ordinance and may pmceed ae requcseed. 1'his d�xument
when signed by the Ciry Planner consntutes a tempurary Certificare of Zoning compiiance and allows cansuuction to commence. Before �xcupancy, a Certificatc of Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for ali inspections (9S2) 447-9850, [ax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372