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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
bate Rcc' Q
File
City
Applicant
I PERMIT NO'qjJ._ L-YO
I White
Pink
''{elJow
(Please
ADDRESS
n at bottom)
(00 -r
W€;s r 6U;
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
O~ER _
(Name) i~4tU .41 ~Y2/e
(Address) /6{J d.. wf:.Sreu~ y
(Phone)
.4 (/ z:
/5" ;)- ~ 9 d. -SS&t
BUILDER
(Company Name)
(Contact Name)
(Address)
~(n/!/l~/AJ6
.;r/J 5 nil )
C,,(J;!.JS'r;
(Phone)
(Phone)
ZONING (office use)
PID
TYPE OF WORK 0 New Construction OOeck OPorch Re oofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition OAlteration OUtility Conne tlOn
CODE: DI.R.C. DI.B.c.
Type of Constmction:
Occupancy Group: A B
Division:
o Mise.
I
E
II
F
I
III
H
2
IV V
I M
3 4
A
R
5
B
S
U
PROJECT COST IV ALUE
(excluding land)
$
I hereby certify that I have hlfnIshed Infmmatwn on this applicatIon whIch IS to the best of my knowledge true and COlTect I also certIfy that I am the owner m authOrIzed agent fm the
t 1 t all con'tructwn wIll conftJrm to all eXIsting state and local laws and will proceed 10 accmdance with submrtted plans I am aware that the buIlding
,lIse Furthermore I hereby agree that the CIty official or a deSIgnee may enter upon the propelty to pertlJrm needed lI1SpCCtlOl1S
~oo9997 ~ s/.;7"//c>8
Contractor's License NO, ' Dare
.--
Park Support Fee
SAC
Permit Fee
$
$
$
$
$
$
I $
$
.(-)"
Plan Check Fee
Water Meter Size 5/8"; I",
State Surcharge
Penalty
. Plumbing Permit Fee
~echanical Permit Fee
Sewer & Water Permit Fee
Pressure Reducer
Sewer/Water ConnectIOn Fee
Water Tower Fee
Builder's Deposit
Other
Gas Fireplace Permit Fee
TOTAL DUE
Paid
Date
~{~.- ~ I
~/~ l 6>5
#
#
$
$
$
$
$
$
$
$
$
#
#
I ~~ceiPt N~~ 714-
ThIS IS to certify that the request 10 the above applicatlllO and accompanymg documents IS 10 accordance with the City Zoning Ordinance and may pmceed as requested TIllS d"cument
when Signed by the Cuy Planner constItutes a temporary CertIficate of Zonmg comphance and allows constructIOn to commence Befme occupancy, a Certificate "f Occupancy mnst be
issued
Planning Director
Date
24 hour noficc for all inspections (952) 447-9850. fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
Special Conditions, if any