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oF FRtp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ��_ �� /�
.. � AND UTILITY CONNECTION PERMIT
� �
+�H1VES��� I. White File � ��, � ��
2. Pink City PERMIT NO .
3 Yellow Appliwm / �•��
Please or rint and si at bottam
ADDRESS ) ` � � ZONING (o�'ice use)
/�_ Uz� �
/
LEGAL DESCRIPTION (ofl�ice use onty)
LOT BLOCK ADDITION PID
OWNER
(Name) cO (Phone)
(Address)
BLTII,DER � �� s � � �
(Company Name) �� �� lZt I ll 1` OCt ta ?' T� (Phone) rP �
(Contact Name) (Phone) '�'1 Z 3 �? 3. &�
(Address) ,,`a �u ��E' ��—`
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re•Roofi ❑Re-Siding ❑Lower Levei Finish ❑ Firepiace
�Addivon �Alteration ❑Utility Connection / ���
(
CODE: ❑I.R.C. ❑I.B.C. iJ '�-
Type of Constiuction: I II III IV V A B PROTECT COST ALLTE S �J19�[� � B�
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
! hcreby certify that I have fumished information on this application which is ta the best of my knowledge mue and correct. 1 atso cercify that 1 am the owncr or authimzed agent For the
above-mennoned pro that all construction wip conform to ail existing state and local iaws and will proceed in accordance with submitted pians. I am aware that the buitdmg
ufficial can revoke th mit for ca rthexmore. I hereby agree that the city official or a designee may enter upon the properry to perform necdcd i�ms.
� X /�S 20/
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 $
Penaity $ Sewer/Water Connection Fee # $
Plumbing Fermit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Bui(der's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $
This Appiication Bernmes Your Buiidittg Pertnit When Approved Paid � R ei t NO.
Date U , � , L
Buildin � Utiicial Date
This �s to certify that the requcsi in the atwve apptication and accumpanying documents is in accordance with the City Zcming Ordinance and may proceed u requcstcd. This document
whert signed by the City Planner cunshtutrs a temporary Certificate of Zoning compiiance and alli�ws conswctinn to commence. Before �xcupancy, a Cernficate ��f Occupancy must be
icsucd-
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9850, fax (952} 447-4245
4646 Dakota Sireet Prior Lake, MN 55372