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oc eitio CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
a to TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
U rs7
4onvEsolt" I. white File PERMIT NO. �r
2. Pink City /2_-6 9z_
3 Yellow Applicant
Plrac..t rp or print and sign at bottom)
ADDRES� ZONING(office use)
/7.20 , ,Qiz0c/ lg. IC_SNe '
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
(O )R / �'° �6t 4 V/� A 5 (Phone) X5;,2 - V/2...-- gZZZ
Name
(Address)
BUILDER ,/ /y c5 2 _ �`--2" W2 "8 2 Z
ompany Name /L'l Phone
•n act 1 a - (Phone)
• •• ess i
TYPE OF WORK 0 New Construction ❑Deck ❑Porch ORe-Roofing Re-Siding ❑Lower Level Finish 0 Fireplace
['Addition Alteration ['Utility Connection / u� NPO p� 'ArC
CODE: DLR.C. DI.B.C. 0 Misc. tV I NPO rS
Type of Construction: I II III IV V A B
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $
(excluding land)
Division: 1 2 3 4 5
I hereby certify that I have furnished informati. 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 and that all sn /ction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official ,,al'e this permit for ju. +r Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X -41/%//./i t _a1J/ ff- /Z
TTM",
re ontractor's License ',.. 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 DUE $ 7C. -75--
This Application Becomes Your Building Permit When Approved Paid f J/3 Receipt N 7. 7A.1Date 1`/y7'/y Byl
i
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 and 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_
PlanningDirector 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