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oF PR��� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
�, �. TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
U �rj
�'� �. wh��e File PERMIT NO. j� _��/�
2 r���; c„
3 Vellow Applicam
Ptease or rint and si at bottorn
ADDRESS ZONING (oc��ce use�
�'�� �`-� lil,� /�� ol. � -�
LEGAL DESCRIPTION (oflf'ice use onty)
LOT BLOCK ADDITION PID
OWNER ,,/j /
(Name) .' c'.� ' iy%rG�ls/� ��9/t � (Phone) ,6t 2 , ✓Sf� ,�5�'Jf>
(Address) ,
BUII,DER ��� ��C � �
(Company Name) �.3 s�/ �' . (Phone) ���^ � 2./- _3 ,ci.�-�
�-
(Contact Name) �� /Z-7'� a' Phone)
(Address) ! y � s� . ' "s�.i /�.i ���S��b �i� J
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alterarion ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. � Misc.
Type of Construction: I II III IV V A B pROJECT COST/VALUE S
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 Z 3 4 5
1 hereby certify that [ have fumished informatian on this application which is ta ihe best of my knowledge true and correct. I alsu certify that I am the owner or author�zed agrn[ for thc
above-mennoned propeity and that all construction will conform ro all existing state and local laws and witl proceed in accordance with submittcd ptans. I am aware that the buildmg
utl"icia! can revoke this permit for ust cause Futt ore. I hereby agree that the city official or a designee may enrer upon the property to perform necded mspectinns.
� X /.��6yg �o � /z_� � /�
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 Permit Fee $ TOTAL DUE $ ��. ��
This Applicallon Bernmes Your Building Petmit When Approved Paid - S Recei t NO. � 1—
Date / B
Buildins Utiicial Dnte
This �s to certify that the request in the above applicanon and accompanying documents is in accordance with the City 7aming Ordinance and may proceed u requcs[ed. Th�s ducument
when signed by the Ciry Planner constuutes a temporary Certificate of Zoning comptiance and aUuws constructiun tu commence. Befure �xcupancy, a Certdicate uf Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for ali inspections (9S2) 447-98Sp, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372