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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
3. 2-1-- (J r
I White
Pink
Yellow
File
City
Applicant
I PERMIT NO. 6~ OIz.-4-t
ZONING (omce use)
I ADDLfdq;- ~rJfI.^'" D
(;A/L
LOT
BLOCK
ADDITION
I
(PhOne1qO--I/);) -07CiJ I
I
PID
LEGAL DESCRIPTION (office use only)
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
~
(Phone)
(Phone)
#0.
9357
/
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing ORe-Siding OLower Level fimsh 0 Fireplace
OAdditlOn OAlteration o Utility ConnectIon
I
E
II
F
1
III
H
2
IV V
I M
3 4
A
R
5
B
S U
PROJECT COST IV ALUE
(excluding land)
$ Jjjl;i)
CODE: OLR.C. OLB.C.
Type of Constmction:
Occupancy Group: A B
Division:
o Mise
'1' or <luthonzed agent tor the
I am a are that the brnldmg
x
Contractor's License No.
Date
Plan Check Fee
State Surcharge
z 500.00
$
$
$
Park Support Fee
SAC
#
#
Permit Valuation
Permit Fee
Water Meter Size 5/8"; I";
Pressure Reducer
Penalty $
Plumbing Permit Fee $
Mechamcal Permit Fee $
Sew", & W"".' P,nnit F" i I
Gas Fireplace Permit Fee ~ $
Sewer/Water Connection Fee
Water Tower Fee
#
#
Builder's Deposit
Other
TOTAL DUE
This Application Becomes Your Building Permit When Approved
llllildl1l~ Unlelal
Date
ThiS IS to certify th,lt the request in the aoove application and accompan)'lI1g documents IS 10 accordance with the City Zlming Ordinance and may proceed as requested. TillS document
when signed by the City Planner constItutes a temporary Certificate of ZLlnmg comphance and allows constrllctlLln tn CLlmmence Befme occupancy, a Ccrtlficate of Occupancy must be
issued
Planning Director
Date
24 hour notice for all inspections (952) .t.t7-9R50. fax (952) .t.t7-.t2.t5
4646 Dakota Street Prior Lake, MN 55372
Special Conditions, if any