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CITY OF PRIOR LAKE BUILDING PERMIT,
ORARY CERTIFICATE OF ZONING COMPLIANCE
ND UTILITY CONNECTION PERMIT
Date Rec' d
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I White
Pink
Yellow
File
City
Applicant
PERMIT NO'1 - \ 12-
LEGAL DESCRIPTION (office use only)
LOT fp BLOCK l ADDITION
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PID Z)- 'Z..o .~..o
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(Address) I 500 bl Ie -mc\Jf
(Phone)
"i~l- ZZ71
(Phone) ~ '5' lUl
(Phone)
TYPE OF WORK 0 New Construction
/ OAdditlOn OAlteration
CODE: [3(R.C. OLB.C.
Type of Construction: I II III
Occupancy Group: A B E F H
Division: I 2
ORe-Siding OLower Level Finish 0 Fireplace
o Mise.
IV
I
3
V
M
4
A
R
5
B
S
U
PROJECT COST IV ALUE
(excluding land)
$ JflJLDIT---
Contractor's License No.
Date
Permit Fee
$
$
$
Park Support Fee
SAC
#
#
$
$
Permit Valuation
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Water Meter Size 5/8"; I";
Pressure Reducer
$
Sewer/Water Connection Fee
#
#
$
$
$
$
$
$
~...-
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
I P,id ~c.. - .
Date lz.+f a 1
I ReceIpt No. ~4~1
B Y (l-I.) V+
ThiS IS to certify that the rcqul', 1 the abu e applicat1oI1 and accompanymg documents is in accordance with the City Zoning Ordinance and may procecd as requested TillS document
whcn signcej by the Clly Planncr Cll .s a tcmporary Ccniticate of ZOl1lng comphancc and allows constructIon to commence. Befme occupancy, a CcrtIficate "f Occupancy must bc
isslIed
Planning Direclor
Special Conditions. if any
Date
24 hour noticc for all insJlcctions (952) ~~7-9850, fax (952) ~~7-~2~5
4646 Dakota Street Prior Lake, MN 55372