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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please
ADDRESS
Date Rec' d
"-/./0.00
White
Pink
Yellow
I PERMIT NO. 00. Oh/~
File
City
Applicant
c/ ~e-L-6
ZONING (office use)
I'<.-ISLJ
~28o
G~/NWO()O
LEGAL DESCRIPTION (office use only)
LOT
ADDITION
(Phone) '11" 3;)2> - .2>/3.J
BLOCK
OWNEt
(Name) '10./\
(Address)
b [' Lv'\ V'\ .e, r
PID25. 034-.005. ()
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
Re-Siding OLower Level Finish 0 Fireplace
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing
OAddition OAlteration OUtiJity Connection
CODE: DI.R.C. DI.B.c.
Type of Construction:
Occupancy Groll A B
Division:
II
F
1
III
H
2
IV V
I M
3 4
A
R
5
I
E
o Misc.
B
S U
PROJECT COST IV ALUE
(excluding land)
$
I have htrOlShed Information on this applicatIOn which is to the best of my knowledge true and correct. I also certtfY that I am the owner or autllllllzcd agent tllt" the
10n property and that all construction will conform to all existtng state and local laws and will proceed In accordance with submllted plans. I am aware that thc building
n re ke thIS permtt for Just cause Furthermore, I hereby agree that the CIty official or a deSIgnee may enter upon the propelty to perform needed tnSpeCtHllls.
7/lo/o~
x
Signature
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
Date
811l1d1lH~ Official
Contractor's License No.
Date
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 $ 1t;,.dtJ
" ,
Paid
Date
?v-
"'7. O.ob
ThIS is to certify that the request in the abuve application and accompanying documents is 10 accordance with the City Zoning Ordinance and may proceed as requested ThiS document
when signed by the City Pl.1nner constitutes a temporal)' Certificate of Zoning compliance and allows construction to commence Before occupancy, a Certificate of Occupancy must be
i.sslIcd
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
If 'G,agle Creek Avenue Prior Lake, MN 55372