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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
ADDRESS
3d-g~
LEGAL DESCRIPTION (office use only)
ADDITION
Date Rec' d
White
Pink
J Yellow
I PERMIT NOO c; --'w 1-13 I
File
City
Applicant
ZONING (office use)
PID / Il~
au,? 0
~'::e~t ); I h 4- th- .,'j)i N I J ~
?~Jt
(Phone)
~s 01. --i/<;O -Sd-.O I
(Address)
BUILDER
(Company Name)
(Contact Name)
(Phone) 5' \" cJ- - 9 ~ 1- ~3 0 0
(Ph9ne) 7' S ol - 77'1 - ~ ~ 0 b
~..
o New Construction ODeck OPorch ~Re-Roofing
OAddition o Alteration DUtility Connelt;~
e-Siding OLower Level Finish 0 Fireplace
1 tU~iCJU,1t4
CODE: OI.R.C. OI.B.C. o Mise.
Type of Construction: I II III IV V A B
Occupancy Group: A B E F H I M R S U
Division: 1 2 3 4 5
PROJECT COST IV ALUE $
(excluding land)
I hereby certifY that I have furnished mformation on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authonzed agent for the
ab<lve-mentloned property and that all construction will nf(Jrm to all existmg state and local laws and will proceed in accordance with submitted plans. I am aware that the bUlldmg
Ill' I can r oke this permIt for J 't cause r r. hereby agree that the City official'lr a designee may enter upon the property to perform needed mspectlllns
6 C:: dO "/-<;<J~ d. , ~ -7 - 0...)
Contractor's License No, Date
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $ I,
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
Blllldllll! Unicial
Date
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; 1"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
,
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ -)6.-
Paid
Date
7&.
I { OS
Receipt No. l-(f{/j (,31
By 1-
ThIS IS to certify that the request m the above applicatIon and accompanymg documents IS m accordance WIth the CIty Zoning Ordinance and may proceed as requested Tim dllcument
when signed by the City Planner constItutes a temporary Certificate of Zonmg complrance and allows construction to commence, Before occupancy. a Certificate Ill' Occupancy must be
issued
Planning Director
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-.U45
16200 Eagle Creek Avenue Prior Lake, MN 55372
Special Conditions, if any