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of PR/0 CITY OF PRIOR LAKE BUILDINGL/
t:
TEMPORARY CERTIFICATE OF ZONING PERMIT
Date Recd
AND UTILITY CONNECTION PERMIT Z _3
I. White File
3 peek ity
100/24
DRESS
ZONING f °fficcuse
i
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION
PID
O _ ER
�•
_
(Address)(Name) ha- Sc.
(Phone) ` Sez- 23 — 6,c2 lo(
BUILDER I L
ompany Name L�, , t t,��,.
.
��ontactNam- "137 .SuKwS N (Phone)�2(l8- 3Y�- 7Y(o�_
mi „Z w C ,, �. (Phone) a kr-- 7 _ 3/61
NM
3l�S�f
CCS,4, c.,..1 4._ 0 .lv . N 5S41(
TYPE OF WORK 0 New Construction ❑Deck
❑Addition ❑Porch ►;RerRoofing ❑Re-Siding
❑Alteration ❑Utility Conn do g ❑Lower Level Finish 0 Fireplace
CODE: ❑I.R.C. ❑I.B.C.
0 Misc.
e of Construction:
I II III IV V A B
ision:pancy Group: A B E F H I M R S U PROJECT COST/VALUE `�
1 2 3 $ �S�
4 (excluding land)
II 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
above-mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
I official can revoke this., •- ;. t cause Fur• * hereby agreecity agent for the
I that the ci official or a designee may enter upon the property to perform needed inspections.
„ Contractor's License No.
i3
Permit Valuation Date
IIIIIIIIIIIIIIIIIIIIIIIIN Park Support Fee # �_
Permit Fee
Plan Check Fee laillimmi
ligagil
Water Meter Size 5/8"; 1"; ®_
Penalty Pressure Reducer $
IUIIIIIIIIIII
Plumbing Permit Fee
- Sewer/Water Connection Fee # $
Mechanical Permit Fee UIIIIIIIIIIIII
Water Tower Fee # $
Sewer&Water Permit Fee Builder's Deposit $
$ Other
Gas Fireplace Permit Fee $laillinn
TOTAL DUE
This Application Becomes Your Building Permit When Approved
Paid '''
aL:'
Date C IMIIIIIIIIImmsei•t No. I• 'i
Buildine Official l ���__
Date /
s to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,
ed proceed as ,srequefOc This document
bet
p� y,a Certificate of Occupancy must
Planning Director
Date
24 hour notice for all inspections(952)447_9850,fax(952)447-4245 Special Conditions,if any
4646 Dakota Street Prior Lake,MN 55372