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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
S 31.0)
1. White File
2 Pink City
3 Yellow Applicant
PERMIT NO. Os-. () 23 /
ADDRESS
/"'15
..::)
6a.~5Wrxxl
Clrtle)
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
J. to Ie...
(Phone)
'5 d. ddG l{- I d-I
IPS
(Address)
BUILDE
(Name)
(Contact Name)
(Address) J 18;;6
C(/l/L gZ;() J 3
TYPE OF WORK
o New Construction
DDeck
OPorch
ORe-Roofing
DLower Level Finish
o Fireplace
DAddition
OAlteration
o Misc.
PROJECT COST IV ALUE (excluding land) $
/710
Contractor's License No.
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
$
$
$
$
$
$
$
$
Park Support Fee
SAC
#
#
Water Meter Size 5/8"; I";
Pressure Reducer
City SAC and WAC
Water Tower Fee
Builder's Deposit
Other
#
#
TOTAL DUE
Re-Siding
OUtility Connection
d~d'9-()5
Date
$
$
$
$
$
$
$
$
$
Paid
Date
~~()O
l,oS-
I ReCjtNo t~...f'>1l
By ~~
This Application Becomes Your Building Permit When Approved
Building Official
Date
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