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CITY OF PRIOR LAKE BUILDING PERMIT,
~ " ~~PORARY CERTIFICATE OF ZONING COMPLIANCE
t~~\,~ ) l AND UTILITY CONNECTION PERMIT
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Date Rec' d
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City
Applicant
I PERMIT NO. /, IOcr/I
(Please
ADDRESS
ZONING (nnice llse)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER \, ~
(Name) .JrM ~k-,^-.J
(Phone) ~ Cf52 ' ~ -(;f72.
(Address)
(Phone) q52- 'i~- 6(56
(Phone)
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c.
TYPE OF WORK 0 New Construction ODeck OPorch Re-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition OAlteration o Utility ConnectIon
CODE: DI.R.C. DI.B.c. o Mise.
Type of Constmction: 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
20126880
Contractor's License No.
//-8-07
Date
Permit Fee
$
$
$
$
$
$
I $
$
Park Support Fee
SAC
#
#
$
$
Iluildlllg Urtlclal
Ilate
Water Meter Size 5/8"; I";
Pressure Reducer
Sewer/Water Connection Fee
#
#
Plan Check Fee
State Surcharge
j Penalty
I Plumbing Permit Fee
~echanical Permit Fee
Water Tower Fee
Sewer & Water Permit Fee
Builder's Deposit
Other
Gas Fireplace Permit Fee
TOTAL DUE
This Application Becomes Your Building Permit When Approved
ThiS IS to certify that the request in the above applicatIOn and ilccompanYll1g documents is in accordance with the City Zoning Ordinance and may proceed as requested. ThIS document
when signed by the City Planner constltutes a temporary Certificate of ZOllmg compliance and allows construction to commence Before occupancy, a Ceruflcate l)f Occupancy must he
isslled
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372