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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
I ~~;;~d~l::; \ o-ke l ~ \
I PERMIT NO. o).---/Ogs-!
ZONING (office use)
RISD
White File
Pink City
Yellow Applicant
LEGAL DESCRIPTION (office use only)
V/~4<V p{/J1 ck d~D
LOT d-aLOCK
ADDITION
OWNER
(Name)
(Phone)
(Address)
BUILDER
(Phone) \a \ k q ~ -, · d--OS~
(Phone)
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
submitted plans. I am aware th t the building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
enter upo the proRerty t p for needed inspections.
(' -.
TYPE OF WORK
~Ck
o Fireplace
o Alteration
o New Construction
OPorch
ORe-Roofing
OLower Level Finish
OAddition
o Misc.
PROJECT COST IV ALUE (excluding land) $
x
~o 130~ 17
Contractor's License No.
Park Support Fee
SAC
#
#
'Z.. c::> a 0 .-
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
$
$
$
$
$
$
$
$
TOTAL DUE
f&> er. l. -
4~. "
(.00
Water Meter Size 5/8"; I";
Pressure Reducer
City SAC and WAC
Water Tower Fee
Builder's Deposit
Other
#
#
ORe-Siding
OUtility Connection
-' ., 3 -0 L
Date
$
$
$
$
$
$
$
$
$
1/-
.s.
I Paid Iff Jt .. I Receipt No. q;~
Date . - . - () 0- By
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
PRIOR LAKE
INSPECTION
RE ORD
SITE ADDRESS7Jcf d kt ~;;h.-/
TYPE OF WORK " ec Ie--
USE OF BUILDING 5 F
PERMIT NO. OJ - //){.;- DATE ISSUED t)'- 3-0 J-
BUILDERJ <f- 1< ~/t'J ~ PHONE # q r7- ~ r;, C:,
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTOR / / OpE
I FOOTING I k'll I 1'/2,/0<- I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I Fnl(UIHG ~. I I I
r FINAL I If/t(. I ~ -1::0 OL I
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (952) 447-9850
,
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