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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
/1- /31 () f,
n at bottom)
ADDRESS
LEGAL DESCRlPTION (office use only)
LOT
BLOCK
ADDITION
OWNE~t ~U'
(Name)
(Address)
White
Pink
Yellcn\'
I PERMIT NO.
File
City
Applicant
r;, . I 0 z..3
ZONING (office use)
PID Z{. z..& 4". O-z.-Z-. 0
(Phone) 35Z - ~Wo- )592
(Phone)
(Phone)
QS?-ql5- 7227
TYPE OF WORK o New Construction ODeck e-Roofing ORe-Siding OLower Level Finish o Fireplace
OAddition OAlteration chon ,,"MISC ~
CODE: DI.R.C. DI.B.c. $41()
Type of Construction: I II III IV V A B PROJECT COST IV ALUE
Occupancy Group: A B E F H I M R S U (excluding land)
Division: I 2 3 4 5
I hereby certifY that I have t\lrnlshed IrJormation 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
above-mentlOned property and that all construction will conform to all eXlstmg state and loeallaws and will proceed in accordance with submitted plans. I am aware that the buildmg
:ficial can revoke this per it for Just Clll ' Furthermore, I here agree that the City official or a deslrO~pon the propelty to perform needed rSfJo(3 lt1. ()
Signature Contractor's License No. Date '
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
Buildlllg Oftlclal
Date
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water ConnectIOn Fee # $
Water Tower Fee # $
Builder's Deposit I $
Other $
TOTAL DUE $
ThIS 15 tu certify that the request in thl~ above application and accompanymg documents is In accordance with the City Zoning Ordinance and may proceed as requested ThIS document
when signed by the City Planner CllnstllUtes a temporary Certificate of Zonmg compliance and allows constructIOn to commence. Before occupancy, a Cerllflcate of Occupancy must be
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