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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
at bottom)
ADDRESS
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Date Rec' d
q~ll. ()b
I White
Pink
Yellow
I PERMIT NO. 0'.0 t>+;J I
File
City
Applicant
ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
(Phone)
OWNER
(Name)
PID z,S- 2-9$'". 0 '7. ()
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(Address)
BUILDER
(Company Name)
(Contact Name)
(Address) ~'-\~ ~
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(Phone) L.\ 41 '=\ b ~ ~
(Phone) to' "'L 1.. 17" '-\ \ ~ ~
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TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition OAlteration o Utility ConnectIOn
CODE: DI.R.C. DI.B.c. o Mise
Type of Construction: I II III IV V A B 19~ c::C:.> . ~
PROJECT COST IV 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 fiJfnIshed mformation on this application which is to the best of my knowledge true and correct. I also certify that I am the ownl'r or iluthonzed agent for the
above-mcntlOned plOpel ty and that a I constt uctton wdl conform yall eXIsttng state and local laws and WIll plOceed m accm dance wIth submttted plans ] am aware that the bUlldmg
otticlal can revokc thIS pel mlt for Just :ausc FllltheImme, ~ agIee that the City offictalor a dCSlgnee may enter upon the plopeIty to perform needed mspectIons
X ~ 7 C\ - '\c;:;. . 0/0
Stgna Contractor's License No Date
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
Buildll1!! Oflieial
Date
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $
0(,
ThiS IS to certify that the request in the above applicatIOn and accompanymg documents is 111 accordance with the City Zoning Ordinance and may proceed as requested. ThiS document
when signed by the City Planner comltlutcs a temporary Certificate of Zonmg compliance and allows construction to commence Before occupancy, a Certificate of Occupancy must be
isslIed
Planning Director
Date
24 hour notice for all inspections (952) 447-9850. fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
Special Conditions, if any