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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please
ADDRESS
/5(,08
/ZBl/()~K-
Date Rec' d
8.3(j. Oft,
I White
Pink
Yellow
File
City
Applicant
I PERMIT NO. 0(;. 0 778/
,eo
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name)
PID 2.S. C+z.. 0 <1 ( 0
(Address)
(Phone)
BUILDER
(Company Name)
(Contact Name)
(Address)
TYPE OF WORK 0 New Construction
DAddition o Alteration
(Phone)
(Phone)
~/...2.&,O"'Y67r
~ 0
e-Siding DLower Level Finish 0 Fireplace
CODE: DI.R.C. DI.B.c. o Misc. --_.~--
Type of Construction: I II III IV V A B PROJECT COST IV ALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: I 2 3 4 5
'nrmation on this application which is to the best of my knowledge true and correct. I also cenify that I am the owner or authorIzed agent for the
ruction WIll conform to all eXlStmg state and local laws and will proceed in accordance with submltted plans I am aware that the buildmg
Furthermore, I hereby agree that the City official or a designee may enter upon the propel1y to perform needed mspectHlns
Permit Valuation Z. 5'00.00
Permit Fee $ .
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permtt Fee $
This Application Becomes Your Building Permit When Approved
Buildlllg Orticial
Darc
2G>~ S''J'I
Contractor's License No.
~- ~t1)1!J
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
ThIS IS to certify that the request In the above applicatIOn and accompanymg documents is m accordance with the Clty Zoning Ordinance and may pmceed as requested. TIllS document
when signed by the CIty Planner CllnStltutl'S a temporalY Certificate of Zonmg comphance and allows construction to commence. Betllre occupancy, a CertIficate of Occupancy must be
isslIed
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372