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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
n at bottom)
-
A\'\1nO\ -rrL.S~
Date Rec' d
] White
Pink
Yellow
File
City
Applicant
I PERMIT NO. O~... S,)~
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
ADDITION
PID
BLOCK
e. UJ d-- ill
~-O(j-?- 00/-
~'::e~R ROCVlelli:- --foOd 6rCz;' ~\
(Address)
(Phone)
0SZ L-\ 4l-l (O(~
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ODeck o Porch Re-Roofing ORe-Siding OLower Level FinIsh 0 Fireplace
DAddillOn DAlteration o Utility Conn ctlon
CODE: DI.R.C. DI.B.c. o Mise.
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
I hereby certify that I have lurmshed mf'lrmation on thIS application which is to the best of my knowledge true an,i Cllrrect. I also certIfy that I am the owner or authOrIzed agent Itlf the
Jbovc-m 'nt 0 ed plOpelty and tlut all constructIOn WIll conform to all eXisting state and local laws and WIll plOceed In accOldance WIth submitted plans I am .!ware that the bluldmg
olfiCl.! t IS el I >n U C \ur\ F~1'eAl~1~~offiClal or a deSIgnee may enter upon the plOpeny to pel farm need~d inspectIons
X ~ orl V 'J '-J'J '-AI \1 \ ~ __ (J) - 22- -'00.
Signature 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 I $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
Buildll1g Urticral
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 $-;~--
?!:.;: -to,
i ~;CC~O 5//):f3
Paid
Date
ThiS is to certity that the request in the above applicatlOn and accompanYll1g documents is in accordance with the City Zoning Ordinance and may procecd as requested. ThiS document
when signed by the City Planner CllnStItutes a temporary Certiticate of Zonmg compliance and allows constructIOn to commence. Bett)re occupancy, a Cerl1ticatl' 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