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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
I. White File I PERMIT NO
2 Pink City . C L - 4' It.,
3 . Yellow Applicant . ""'
SO. E.
ZONING (office use)
EtsD
M I -to c 14 [LL C I/Z C L fi..
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID;)S- /55" 0 ;;</-()
OWNER
(Name)
I.,\,'Z ~ ik s
1- b 1. \
t..( '4'1 . 5' ~ t..l S-
o~. LAk-E.
(Address)
S,( .
BUILDER
(Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK
o New Construction
ORe-Roofing
ORe-Siding
R i: <'L A.e i. I\c {' NT \) k C=k.
lEJ Misc.'" _ e ~ I
OLower Level Finish
PROJECT COST IV ALUE (excluding land) $
eck
o Porch
OAddition
o Utility Connection
o Fireplace
OAlteration
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 and that all construction will conform to all existing state and local laws and will proceed in accordance with
submi ns. I am...... awar. e t:b.a... ~ ~~ing official can revoke this permit for just cause. FUrtherm. ore, I hereby agree that the city official or a designee may
~)/r~pe.JYr:rm!\ ~~s c' ns. IV 1,.1
Signature Contractor's License No. Date
Permit Valuation 1500.-
Permit Fee $ 54_~
Plan Check Fee $ 35,'0
State Surcharge $ , 7C;-
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ 8Cf.f3 (;
1LjtfQ/6S;
- ..J 0 -- c:r-
I Receipt No. !jP7t/6
By Cj&-
Paid
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.
Planning Director
Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
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