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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
to.B.Ot,
~b
/~(,70
LVO/IJS
I White
Pink
Yellow
File
City
Applicant
\ PERMIT NO.
0(,.095"'41
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
\ OWNER
(Name)
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
TYPE OF WORK
CODE: OI.R.C. OI.B.C.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
F
I
III
H
2
IV V
I M
3 4
A
R
5
(Phone)
(Phone)
rs~- .;l;ll- ~/ 3 0
":t
DRe~Siding DLower Level FinIsh 0 Fireplace
o Mise.
B
S
U
PROJECT COST IV ALUE
(excluding land)
$
I hercby certify that I have furnished mformatioo on this applicatIon which is to the best of my knowledge trlle and correct. I also certify that I am the owner O!" authOrized agent for the
Jb"ve~mentl"ned pmperty and that ,Ill construction Will CLlnform to all eXlstmg state and local laws and will proceed m accordance with submllted plans I am Jware that the blllldmg
"mClal can evoke t1m perml ust use Furthermore. I hereby agree that the Clty official or a deSignee may enter upon thc propel1y to pert(Jrm necded mspectl<lI1s
x
re
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
I Penalty $
Plumbing Permit Fee $
Mechamcal Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
Butldlllg Unlclal
Date
Contractor's License No
/0-' :;-3-oC;
( Date
Park Support Fee
SAC
#
#
$
$
$
$
$
$
$
$
$
Water Meter Size 5/8"; 1";
Pressure Reducer
Sewer/Water Connection Fee
#
#
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
ThiS IS to certify that the request in the abuvl' applicatiOn and accompanymg documents IS in accordance with the City Zuning Ordinance and may proceed as requested ThiS document
when signed by the City Planner constllutes a temporary Certificate of Zonmg comphance and allows construction (() commence Before occupancy, a Certlficate of Occupaney must be
issued
Planning Director
Special Condilions, if any
Date
24 hour notice for all inspections (952) 447~985(), fax (952) 447~4245
4646 Dakota Street Prior Lake, MN 55372