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o � pR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT � ' � 3 ' � �
U �
~ �NpggO'�� � wn��e File pERMIT NO . �� /��
2. Pink City
3 Yellow Applicam
Please e or rint and si at bottom)
ADDRESS ,� ZONING (ott use>
5 7�5" 1�`a �`` sT S
LEGAL DESCRIPTION (oflfice use only)
LOT BLOCK ADDITION p�
OWNER
(Name) (Phone)
(Address)
BUII.DER
(Company Name) C/'�i f R� v e,•- /jlG.�, e.�M�/ e�r ��S � �` (Phone) �y a �/ %v / 7 r' �
(Contaet Name) �� � � � �7� 5h (Phone)
(Address) f 6 a �o S% /�/5� �• j L. N
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V 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 hcreby certify that 1 have flimished information on this application which is ro the best of my knowlcdge true and correct. I also certify that 1 am the owncr or authonud agent for the
above-mennoned property and that all construction wiU conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that thc buildmg
official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the properTy ro perform necded mspechons.
X/f �" �J..%�-� � 3 � 63 � 933 3-/3 �1 d-
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 $
Penalty $ Sewer/Water Connection Fee # $
Piumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Pe=mit Fee $ TOTAL DUE $
This Apptication Becomes Your Building Permii When Approved Paid Rece' No.
Date �. /� B .
Buildina Utticial Date
This �s to certify that thc requcst in the above applicanon and accumpanying documents is in accordance with the Ciry Zoning Ordinancc and may proceed as requcsted. Th�s document
when signed by the City Planner consututcs a temporary Certificate of Zoning compliance and allows cunstruction to commence. Before uccupancy, a Certificate uf Occupancy must be
issucd
Planning Director 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