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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
2,fj ob,
File
City
Applicant
I PERMIT NO.C.&, ()o!371
White
Pink
3 Yellow
(Please
ADDRESS
n at bottom)
.3 () 9 J 1--/1 /c6
H7II/t;:.-:Aj
(f~7.
ZONING (officc use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
,,'
PID 25. sll. 00:.. ()
OWNER
(Name)
(Phone)
(Address)
(Address)
TYPE OF WORK 0 New Construction ODeck OPorch o Re,Roofing
OAddition OAlteration OUtility Connection
CODE: OI.R.C. OI.B.C.
Type of Constmction:
Occupancy Group: A B
Division:
o Misc.
I
E
II
F
1
III
H
2
IV V
I M
3 4
A
R
5
B
S
U
PROJECT COST IV ALUE
(excluding land)
$
o Fireplace
I hereby certily that I have furnished mformation on this application which IS to the best of my knowledge true and correct. I also certlly that I am the owner or autho!lzed agent for the
above-mentIOned property and that all construction ill conform to all existmg state and local laws and will proceed in accordance with submitted plans. I am aware that the blllldmg
official can r' lke this ~erm.Jt f~r ust c.~~s E rth more, J hereby agree that the City official or a designee may enter upon the propelty to perform needed In' ectlOns
/ >
/,
Contractor's License No.
Park Support Fee
SAC
Permit Fee
$
$
$
$
$
$
I $
$
TOTAL DUE
Plan Check Fee
Water Meter Size5/S"; I";
Pressure Reducer
Sewer/Water Connection Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Water Tower Fee
Builder's Deposit
Other
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
#
#
#
#
$
$
$
$
$
$
$
$
$
This Application Becomes Your Building Permit When Approved
. () (",
BuildlllQ OI1icial
Date
ThIS IS to certlly that Ihe request in the above applicatIon and accompanymg documents is m accordance with the CIty Zoning Ordinance and may proceed as requested ThIS document
when signed by the City Planner constItutes a temporary Certificate of Zonmg compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
isslIed
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections
16200 Eagle Creek Avenue