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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
4./0.0Gi
1 White
Pink
Yellow
File
City
Applicant
PERMIT NO. 00 . 02-40
'17[/L _
ZONING (office use)
r/(~/'; Iv Ie L I "'-'I
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID ZS-, () '2-~ (;(>4-. i
OWNER ~
(Name) ~ If "'" J
7 / -
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
TYPE OF WORK 0 New Construction ODeck OPorch
OAddition o Alteration o Utility Conn
(Phone)
(Phone)
(Phone)
~.I
Re-Roofing
tIOn
ORe-Siding
o Fireplace
OLower Level Finish
CODE: DI.R.C. DI.B.C. o Misc.
Type of ConstnIction: 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 Immshed mfmmation on this application which IS to the best of my knowledge true and correct. I also cerlify that I am the owner or authOrized agent I'll the
above-mcntlOned property and that all construction Will conform to all existmg state and local laws and will proceed in accordance with submitted plans I am aware that the bUlldmg
official ca ke tlus permll for cause Furthermor' . y agree that the City official or a deSignee may enter upon the propeJ1y to perform needed mspecliol1S
"t..
,
./
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
I Plumbing Permit Fee $
I
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
13uilchng Onicial
Date
Contractor's License No.
Jf--ICJ ,-~~
Date
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; 1"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ 7fv.OO
" .
Paid
Date
'/e.. () (J
-1./1 vi:.
5;.;.,] 0
I Reqrlpt No.
~.
U
This IS to certify that the request in the above applicatIon and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested TillS document
when signed by the City Planner constItutes a temporary Certificate of Zonmg compliance and aflows constructlOn to commence. Before occupancy, it Certllicate 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