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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please
ADDRESS
L 700
Date Rec' d
? /1. GY
I While
Pink
Yellow
I PERMIT NO. C/o 0 3~ / I
File
City
Applicant
ZONING (llffice use)
f. tV i..
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
(Phone)
(Address)
BUILDER - rf' ~ J
(Company Name) r/r..5 f C/tOI(.R Llal/c.ul f Z:J/1 ~ .
(Contact Name) ':to ~p h JIIl(r y ~ l~ ~
(Address) - J'. IctL'
TYPE OF WORK 0 New Construction ODeck OPorch
OAddition OAlteration OUtility Conne
?J ?~v:2t; -~?C ~
ORe-Siding OLower Level Finish 0 Fireplace
CODE: DI.R.C. DI.B.c. o Misc.
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
I hereby certify that I have hlrnished mformation on this applicatIOn which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent tor the
<lhoVe-mentlllned property and that all Clmstructllln wtll conform to all eXIslIng state and local laws and Will proceed in accordance with suhmltted plans I am aware that the hutldrng
otflcial can revllk' 1lS permIt for Just cause Furthermore, I herehy agree that the City official or a designee may enter upon the propel1y to pertllfm needed rnspectlons
x
Signature
CJ2-...
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
I Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permtt Fee $
This Application Becomes Your Building Permit When Approved
HUlldlllg Uniclal
Date
:;;031?9'1~
Contractor's License No.
~-II-O?
Date
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 IS to certify that the request m the above applicallon and accompany 109 documents is 10 accordance with the City Zoning Ordinance and may proceed as requested TIllS document
when signed by the City Planner cnnstltutes a temporary Certificate uf ZonlI1g compliance and allows construction to commence Before nccupancy, a Certlticatc of Occupancy must be
issued
Planning Direetor
Special Conditions, if any
Date
24 hOllr notice for all inspections (952) .t.t7-9850. fax (952) .t.t7-.t245
4646 Dakota Street Prior Lake, MN 55372