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ADDRESS
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
r\ ~~ liTILITY CONNECTION PERMIT
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File
City
Appl1cant
PERMIT NO'6? 0814-
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3n)I~
LOT
BLOCK
LEGAL DESCRIPTION (office use only)
ADDITION
PID
Date Rec'd
9, il.'!
ZONING (office use)
OWNER
(Name)
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(Address)
BUILDER
(Company Name)
(Contact Name)
(Address) 5~
(Phone)
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(Phone)
(Phone)
Cf5'2-t$-2S<fl
0; >L - 3 93> -- 8576
TYPE OF WORK 0 New Construction
DAddition DAlteration
DLower Level Finish D Fireplace
CODE: ~.R.C. DI.B.c. DMisc.
Type of Construction: I II III IV V A B PROJECT COST IV ALUE $ /8fXJo
Occupancy Group: A B E F H I M R S U (excluding land)
Division: I 2 3 4 5
, hlfmshed mformation on this application which IS to the best of my knowledge true and correct. I also certify that I am the owner or authonzed agent for the
t all (ll!1strllctlOl1 will conform to all eXIsting state and local laws and will proceed in accordance with submlttco plans_ I am aware that the build10g
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Contractor's LIcense No Date
x
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
$
$
$
$
$
$
I $
$
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 Application Becomes Your Building Permit When Approved
Iluildlllg Urticial
Date
$
$
$
$
$
$
$
$
$
..00
ThiS IS to ceTtlfy that the request 10 the above application and accompanY1Og documents is in accordance with the City Zoning Ordinance and may prucecd as requested ThIS document
when signed by the City Planner Cl)J1Stttutcs a temporaty Certificate of Zoning compltance and allows constructIOn to commence. Before occupancy, a Ccrtlticatc ()f Occupancy must be
issucd
Planning Director
Date
24 hour noticc for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
Special Conditions, if any