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o F pR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
��NNES��� 2. I'iok c�Y PERMIT NO . �� —����(
3 Yellow Applitam
Please or rint and si at bottom)
ADDRESS ZONING (oFlFice use)
� G� C L����'=�'Q ,�y��J � /= /� J
LEGAL DESCRIPTION (of�'ice use only)
LOT BLOCK ADDITION pID
OWNER �/' / �--•
(Name) _T��'�/��.G' S/ cr ��:: � (Phone)
(Address) ,� QG �� �'�,� '—
BUII,DER � ,.
(Company Name) f2 �e�7� 1�. / �� (Phone) ��'J'�'`7 / Q��
(Contact Name) � (Phone)
(Address) �' /�(f ST
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utiliry Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV Y A B pROJECT COST/VALLTE $���
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5 '
I hereby certify that I have fumished information on this application which is to the best uf my knuwlcdge true and coRect. I also certify that I am the uwncr or authonud agent for the
abuvc-menhoned o•rry and that all cunstru on will conform to all existing stare and local laws and will proceed in accordance with submittcd plans. I am aware that the buildmg
otf'icial can rev e thi permit for just use. Fw e re, I hereby agree that the city oflicial or a designee may enter upon the pro erty to prrform necded mspections.
X �� � r� � z
Signature Contractor's Lic nse 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 DLTE $ � 7�"
This Application Becomes Your Building Permit Whrn Approved Paid ReCei O L
Date L.. B
Buildim� Utticial D�te
Th�s is ro certify that the requcst in the above applicahon and accumpanying documents is in accordance with the Ciry Zoning Ordinancc and may proceed as requcsted. Th�s documcnt
whcn signed by the City Planner conshtutcs a temporary Certificate of Zoning compliance and allows construction to commence. Before uccupancy, a Ccivticuc of Occupancy must be
issucd
Planning Direcror 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