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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
7./tJ,Ob
(Please
ADDRESS
White File
Pink City
Yellow Applicant
I PERMIT NO. O(P, Ot;,/3./
3300
S t2/U./ e&
ZONING (office use)
772/1/ L-
K/JO
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID Z-J: /7 z < i.)~Z, 0
(Phone)
(Address)
Tr fit L
I BUILDER VI t<
I (Company Name) J
I (Contact Name)~~~
I (Address) Cj()/. "
(Phone) b~J -Zt< .-/06'1
(Phone)
TYPE OF WORK 0 New Construction ODeck DPorch ORe-Roofing
DAddition OAlteration DUtility Connection
DLower Level Finish 0 Fireplace
CODE: OI.R.C. OI.B.C.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
F
I
III IV V A
HIM R
2 3 4 5
B
S U
PROJECT COST IV ALUE $
(excluding land)
rmshed mt(Jrm' IOn on this applicatIon which IS to the best of my knowledge true and correct. I also certIty that I am the owner or authOrIzed agent for the
at all COl ruction,;vill conform to all existIng state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
JUS Ca e Furthermore, hereby agree that the CIty official or a deSIgnee may enter upon the propeny to perform needed mspectlons
x
Contractor's License No.
'1- /0- 06
Date
Permit Valuation
Permit Fee
$
$
$
$
$
$
$
$
Park Support Fee
SAC
#
#
$
$
$
$
$
$
$
$
$
.of
Plan Check Fee
Water Meter Size 5/8"; I";
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Pressure Reducer
Sewer/Water Connection Fee
#
#
Water Tower Fee
Sewer & Water Permit Fee
Builder's Deposit
Other
Gas Fireplace Permit Fee
TOTAL DUE
This Application Becomes Your Building Permit When Approved
Paid
Date
~~;()~
I#tNO
7?~2--
Huildll1g Orticial
Date
ThIS IS to certlty that the request In the above applicatIon and accompanYIng documents is In accordance with thc City Zoning Ordinance and may proceed as requested ThIS document
when signed by the City Planner constItutes a temporary 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
16200 Eagle Creek Avenue Prior Lake, MN 55372