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of PR / CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
0 ,� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 7 z �
AND UTILITY CONNECTION PERMIT
�kNESOit* 1. White File / 3 2. Cit PERMIT NO. yo3
3 Yellow Applicant �`'
(Please type or print and sign at bottom)
ADP ZONING (office use)
q 1 7 1 X kktfil b
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER c� p S S C � IM 0 ( Ph one ) �l -Z3 � �� � a
(Name) / � C - C_ / i r ,Q //
(Address) Li c 9K /t) 6/ r
74 / A/Z
BUILDER �1 / �-� v� V $ 9 9
(Company Name) (P,,�j ' 3� 3 ' t
(Contact Name) 7 1 'e rc Ct Pi - (Phone)
(Address) 7 `f / �� vi c f t �'
TYPE OF WORK ew Construction DDeck DPorch e Roofing DRe- Siding DL.ower Level Finish D Fireplace
DAddition DAlteration ❑Utility Conne io
CODE: DI.R.C. DI.B.C. 0 Misc.
Type of Construction: I II HIP/ V AB G
PROJECT COST /VALUE $ t
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 furnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above - mentioned property an tr construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke this p•rmit f lust use Furthermore, I hereby agree that the city official or a designee may enter upon the pro rtY to perform needed Inspections.
x e 7� �_
lure Contractor's License No • 4a - ^
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 DUE $
C
This Application Becomes Your Building Permit When Approved Paid Rtreipt No.
Date ? Z- , 13 IV ,
Building Official Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance a . may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372