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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
II. Z(). 0'
(Please
ADDRESS
/ ~e 13 ,M?I;1J t6 7?ZA'1 t..--
I White
Pink
Yellow
[PERMITNO. G./64-S-1
File
Clly
Applicant
ZONING (officc use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name)
PID 2.5. I:J~. (j z. 7. 0
(Phone)
(Address)
(Phone)
(Phone)
~S/-s9g-9Y"?7
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing
OAddition OAlteration OUtility ConnectlOn
e-Siding OLower Level finish 0 Fireplace
CODE: DI.R.C. DI.B.C.
Type of Constnlction:
Occupancy Group: A B
Division:
IV V
I M
3 4
A
R
5
II
F
I
III
H
2
I
E
o Mise.
B
S U
PROJECT COST IV ALUE $
(excluding land)
I hereby certify that I hav' furmshed mformatlOn 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
abllVl'-mentlOned proper and that all CD trucllon WIll Cllnti)rm to all eXIstIng statc and local laws and Will proceed in accordance with submItted plans I am aware that thc buildIng
~JiClal can revoke tillS r It fur Just c 'Furthermore, I hereby agree that the City official or a deSIgnee may enter upon the propeI1y tll perform needed;;/20 /U
Contractor's License No. Date .
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
I Penalty $
I Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
Huildlll!! Ufflclal
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 $ 7C.~CIU
This lS to certify that the requl'st In the abnve application and accompanYing documents is In accordance with the City Zoning Ordinance and may proceed as requcstcd This document
when signed by the City Planner cnnstltutes a temporal)' Certificate of Zonmg compliance and allows construction to commence Before occupancy, a Certificate 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
4646 Dakota Street Prior Lake, MN 55372