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I PERMIT NO.03 - ! lost
I
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
White File
Pink City
Yellow Applicant
(P~~ """ h" ~d ,i", ,,00"":
I ADDRESS
4\ (Jfn\(\ ~ (tfdf Wg-
tq6 Ct
Date Rec' d
ZONING (office use)
'c, Sf)
LEGAL DESCRIPTION (office use only)
LOT
ADDITION
PID d5-0 3)-00 fo-C
BLOCK
I g.~~ ~~cJ\~~ ~~-
(Address) '., fu '<l it~ 8 "
(phOne)(@ -LBO.dlJiJ
ltJ513 81o-Cf8€J8
I hereby certify that I have furnished information 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 existing state and local laws and will proceed in accordance with
submitted plans. I am aware that the building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
enter on the property rform ded inspections.
.6)
1j~~_~ I ~;ceiPtNOij'P I
/
TYPE OF WORK
DDeck
OPorch
ORe-Roofing
o New Construction
DLower Level Finish
o Fireplace
DAlteration
OAddition
~Misc. .
COST IV ALUE (excluding land) $
x
$
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"; 1";
Pressure Reducer
#
#
City SAC and WAC
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
This Application Becomes Your Building Permit When Approved
Paid
Date
Building Official
Date
~Re-Siding
DUtility Connection
d-Ll'03
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