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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
1. White File
2 Pink City
3 Yellow Applicant
I PERMIT NO. 6.:l.-0 7~
ZONING (office use)
V\.
s-\-o
LEGAL DESCRIPTION (office use only)
LOT
ADDITION
PID
L{Ql-,!;" 70S
BLOCK
OWNERT"\_ D
(Name) _1..Ru. '^- '" l ))(
(Address) S r.... ~ n
(Phone)
s~~
BUILDER
(N ame)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK
OPorch
ORe-Roofing
ORe-Siding
o New Construction
ODeck
o Lower Level Finish
o Fireplace
OAlteration
o Addition
Misc. 0... Lo\
PROJECT COST IV ALUE (excluding land) $
OUtility Connection
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
submitt a. I am aware that the buildi official evoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
enter on the roperty to p rform n i e~
X
Contractor's License No.
Park Support Fee
SAC
#
#
Permit Valuation
Permit Fee
Plan Check Fee
Water Meter Size5/8";l";
Pressure Reducer
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Sewer/Water Connection Fee
Water Tower Fee
#
#
Builder's Deposit
Other
TOTAL DUE
Building Permit When Approved
I Paid ~
Date <.,...\ -
~o
t,-Il
Date
Date
$
$
$
$
$
$
$
$
$
;;2 9~
42rn
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 bf
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