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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
File
City
Applicant
PERMIT NO.~ -9 4~
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ADDRESS
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LEGAL DESCRIPTION (office use only)
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ADDITION
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ZONING (office use)
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TYPE OF WORK 0 New Construction OOeck OPorch
OAdditlOn OAlteration o Utility Con
ORe-Siding
OLower Level FinIsh
Re-Roofing
ctlOn
CODE: DI.R.C. DI.B.c. o Mise
Type of Construction: 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
~$' CJ y::;.--
o Fireplace
I hereby certify that I hav' rnished mformatIon on this application which 1$ to the best of my knowledge true and correct. I also certify that 1 am the owner or authorized agent for the
above-mentIOned proper (ld tl t all constructiull wi 1 conform to all existmg state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
off .., tlus ~ r It fo Just cause re, I hereby agree that the CIty official or a designee may cnt on the property to perform needed mspectHlnS
Co
Permit Valuation
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Water Meter Size 5/8"; I";
Pressure Reducer
Park Support Fee
Permit Fee
$
$
$
SAC
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer/Water ConnectIOn Fee
Water Tower Fee
Builder's Deposit
Other
Sewer & Water Permit Fee
TOTAL DUE
Paid
Date
;:r~~I-
Receipt NO~, ~\ ~
By
#
#
#
#
[late
$
$
$
$
$
$
$
$
$ 4~o. "2..L
ThiS IS to at the request in thc_above a lic accompanymg documents IS m accordancc with the City Zoning Ordinance and may proceed as requested ThiS document
when signed by the CIty Planner Ctlnstlllltes a tempmalY Certificate of limIng complIance and allows constrUC!lon to commence Befme occupancy, ,1 Certificate 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