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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec'd
f ~ r" -l/7
File
City
Applicant
[ PERMIT NO. 0 7. 0717
I White
Pink
Yellow
n at bottom)
ADDRESS
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name) JOH'tU
(Phone)
q 5 ff/ft(. 0,.0 ./'Ut/;6{A Y
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
5t~A(~-~J/U6
-:J45atU
(Phone)
(Phone)
9s- d;l-~ ";2. - 5'826
./ L//OS r:
TYPE OF WORK 0 New Construction ODeck OPorch
OAdditlOn OAlteration o Utility Conn
ORe-Siding OLower Level Finish 0 Fireplace
CODE: DI.R.C. DI.B.C.
Type of Construction:
Occupancy Group: A B
Division:
o Misc.
I
E
II
F
I
III
H
2
IV
I
3
V
M
4
A
R
5
B
S
U
PROJECT COST IV ALUE
(excluding land)
$
I hereby cntity that I have hlrmshed IOI'JrmatJon on this applicatIOn which IS to the best of my knowledge true and correct. I also certIfy that I am the owner ()J authonzed agent lor the
above-mentlllned proper and that all construction WIll confDfm to all eXIsting state and local laws and will proceed 10 accDfdance with submItted plans. I am aware that the buildlOg
official can rc IS permit for JUS ~ lIt ermore, I hereby agree that the CIty official or a deSIgnee may enter upon the propeny to perform needed mspcctmns
o/~~o/
D, e
d,00999 /?
Contractor's License No.
Park Support Fee
SAC
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permit Fee $
Water Meter Size 5/8"; I";
Pressure Reducer
Sewer/Water ConnectIon Fee
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
This Application Becomes Y our Building Permit When Approved
Ilulidlllg Uffielal
Dale
#
#
#
#
$
$
$
$
$
$
$
$
$
ThiS IS to certify that the request in the abllve applicatlOn and accompanYlllg documents is in accordance with the City Zoning Ordinance and may procced as requested TillS documcnt
wht'll Signed by the City Planner COnstltutcs a tempnrary Certllicate of Zonll1g compliancc and allows constructIon tll commence. Bef'lre occupancy, a CcrtIlicatc of Occupancy must be
issued
Planning Director
Date
24 hOllr notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
Special Conditions, if any