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o � PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, ,� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
.�', � AND UTILITY CONNECTION PERMIT
U �rj
4�NNeso�� � whiie File
Z �;�, � PERMIT NO. I L=�L�i !�
3 Yellow Applicnm
Please or rint and si at bottom �
ADDRESS ZOIVING cott usc)
1 y$S �- r �`► r�d .
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION P1D
owivER �'� � . �.1�5� 59
(Name) �a'nC.� �'J�(J-p �n�(' (Phone) �
(Address)
BUII.DER
(Company Name)��-f�1C����'�Y��CSP-�'� (Phone) �DS�"o��0y" y ���
(Contact Name) (Phone)
(Address) �� � �. �d. �. � � W �.S'E'' ' � � �� � � �
TYPE OF WORK ❑ New Conswction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Firepiace
❑Addition DAlteration ❑Utility Connection ��,� a dpC�(S C�: r► �7Ci STl (�
CODE: ❑I.R.C. ❑I.B.C. _. ❑ Misc. �/�'
Type of Construction: I` II III IV V A B PROJECT COST/VALiTE $ �T/ ��� �
Occupancy Group: A B E F H I M R S U (excluding land)
Division: ` 1 2 3 4 5
1 hereby certify that 1 havr fiimished mformation on this application which is w the brst of my knuwlcdge true and corrrct. 1 alsu certify ehat I am the uwner or authonzed agent for thc
abuve•mennoned prope� and that all construction will conform to aU existing state and local laws and wiil proceed in accordance with submiucd ptans. t am awarc that the buiWmg
official can revoke this 'mit for just cau Funhermore, I hereby agree that the ciry official or a designee may enter upon the property to prrform needed �nspecui>ns.
X '�C 13 a9 g3 �Oc�/a
SignaNre . 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 S Other $
Gas Fireplace Permit Fee $ TOTAL DiJE $
This Application Becomes Your Bui(ding Perntit When Approved Paid Recei t O L
Date U B
BuilJina Utlicial Date
Th�s is tu certify that thc rcqucst in thr abuvr applicaunn and accumpany�ng documents is in accordance with thc City Zcming Ordinance and may proceed as requcsud. Thu dixument
when signed by the Ciry Planner cunsurotes a trmpurary Certificate of Zoning compliance and allows construction ro commence. Befoi �xcupancy, a Certdicate nf Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour noticc for sll inspections (952) 447-9AS11, fax (9S2) 447-�1245
4646 Dakota Street Prior Lake, MN 55372