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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
n at bottom)
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I PERMIT NO. 67. 0 4- 3~
File
City
Applicant
ZONING (office use)
K..€- M.N
5S37~
LEGAL DESCRIPTION (ollice use only)
LOT
BLOCK
ADDITION
PID Z~. (lAB. UZt. U
OWNER
(Name)
C. \ C\yk
(Phone)
4s~- '(-4-7- ;;tP~8>
LAy\'"'~
(Address)
ame)
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ODeck o Porch Re-Roofing ORe-Siding OLower Level finish 0 fireplace
OAdditlOn OAlteration o Utility Conn tl
CODE: DI.R.C. DI.B.c. o Mise.
Type of Constmction: I II III IV V A B PROJECT COST /V 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 turOlshed mtillmatlOn on this applicatIOn whIch IS to the best of my knowledge true and correct. I also certify that I am the owner or autl1<lnzed agent tin the
abovl'-mL'ntlOl1cd property and that all constructlOn will confnrm to all eXlst10g stat(' and local laws and will proceed in accordance with submitted plans_ I am aware that the buildmg
"fliela! can revoke t11lS permit Illr Just cause Furthermore. I hereby agree that the city official or a deSignee may enter upon the propel1y to perlllrm needcd llIspectl<l11s
x
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
Iluildlllg Oftieial
Date
Contractor's License No.
~- 1--07_
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 $ 'l(P- 00
Paid
Date
o. 55 t"
ThiS IS to certify that the request 10 the abllve appl1catlOn and aCCl)mpanymg documents is in accordance with the City Zoning Ordinancc and may procced as requested TillS document
when signed by the City PI.lnne!" cnllstltutcs a temporary Certificate of ZOl1mg compliance and allows construction to commence Befnre occupancy, a Certificate of Occupancy must bc
issLled
Planning Director
Special Conditions. if any
Date
24 hour notirr for all inspections (952) 447-9H50, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372