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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
~ ~~~ UTILITY CONNEC~N PERMIT
e~ r:IZ~efJ ~~ ~ : ~;;,:"
n at bottom)
Date Rec' d
f. ( S. () 7
File
CIty
Applicant
I PERMIT NO. 07. OB1~1
(Please
ADDRESS
ij!27
G
~~rJ
~~
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
ZONING (office use)
OWNER
(N ame)
(Phone)
(Address)
(Phone) Cf5Z-'1Z5,-.t;15b
(Phone)
4U
~..u-
TYPE OF WORK 0 New Construction ODeck
OAdditlOn OAlteration
ORe-Siding OLower Level Finish 0 FIreplace
CODE: DI.R.C. DI.B.c.
Type of Construction:
Occupancy Group: A B
Division:
o Misc.
B
S U
A
R
5
IV V
I M
3 4
III
H
2
II
F
1
PROJECT COST IV ALUE
(excluding land)
I
E
$
at I have rOlshed mformation on this application which is to the best of my knowledge trut.' and correct I also certify that I am the owner or authorIzed agent for the
. nd that all CllnstrtlCtllln will conform to all eXlstmg state and local laws and will proceed m accordance with submitted plans I "m awale that the blllldmg
It fm Ju,t cause Furthermore, I hereby "gree that the City official or a deSignee may enter upon the propeny to per!iJrm needed mspecl10ns
q-/3~D-
Signature Contractor's License No. Date
Park Support Fee
SAC
#
#
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permtt Fee $
Water Meter Size 5/8"; 1";
Pressure Reducer
Sewer/Water Connection Fee
#
#
Water Tower Fee
Builder's Deposit
Other
TOT AL DUE
This Application Becomes Your Building Permit When Approved
BlIildJ1l~ Ufticlal
Date
$
$
$
$
$
$
$
$
$
ThlS IS to certify that the request 10 the above applicatIOn and accumpanymg documents is 10 accordance with the City Zlming Ordinance and may proceed ilS requested ThIS document
when signed by the CIty Pl,1Oner constItutes a temporary Certificate of ZOlllng compliance and allows construction lL1 commence Before occupancy, a Certlfkate of Occupancy must he
j,sslIcd
Special Conditions. if any
Planning Director
Date
24 hour notice for all inspections (952) 447-9!l50, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372