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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
/0. II. oS
(Please
ADDRESS
I White
Pink
3 Yellow
File
City
Applicant
PERMIT NO. OS. 10 1/
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PIDZ.o.OZ.I. oaz.lJ
OWNE~
(Name). ..yfl
Me.. c. uj \ (JU C'i \c___
\
S.
(Address)
BUILDER
(Company Name
(Contact Name)
(Address)
(Phone) q~J:Y -l\l\b - 31 '6 \
C:OC '2 7 ~
t;t:xJ3"
(
TYPE OF WORK 0 New Construction ODeck o Porch ORe-Roofing .~Re-Siding OLower Level Finish .0. Fireplace
OAddition OAlteration OUtility Connection 0 Mise. ri(Qp.Jb-<.Uz-liUUd l~ I rrl~S
CODE: OLR.C. OLB.C. PROJECT COST/VALVE $ ILl '039
Type of Constmction: I II III IV V A B (excluding land)
Occupancy Group: A B E F HIM R S V
Division: I 2 3 4 5
I hereby certify that I have hlrnished mf']J"mation 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 eXlstmg statc and local laws and will proceed in accordance with submittcd plans I am aware that thc buildmg
off.cial can revo~c _ Furthermore, I hereby agree that the CIty official or a deSignee may enter upon the property to perform needed lnspect!(m~
X 'iZJ / ~ ~U,l1.-- i 7 CD 9/ 0:-1. vs-
Stgnature Contractor's License No. Date
Permit Valuation
Permit Fee $ I to. C>.:::;
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 Pennit When Approved
BuildllH! Otliclal
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 DVE $ -/(.0. C()
ThIS IS to certifY that the request m the above applicallon and accompanying documents is m accordance with the City Zoning Ordinance and may proceed as requested. ThIS document
when signed by the City Planner CLlnSlltllleS a temporary Certificate of Zonrng compliance and allows construction to commence, Before occupancy, a Certificate of Occupancy must bc
issued
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372