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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Re~ Jj
1(. "..04
File
City
Applicant
I PERMIT NO. ~. 73&
I
I White
Pink
Yellow
~f AI~
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
s f-{/fel6e~
~(jf:Je rs 5 AI~
r~e
(Phone)
(Phone)
6S1 dd73/YtJ
681 71S C//K-6
(Address)
K.. 0( r L- I'L
/L{fJlS
(Phone)
7' -:5 60 I gOa-g-
BUILDER
(Company Name) 6'"UJ2.. (',
(Contact Name) -----k.s;
(Address) ~ 7 0 ~G
Ca'1 ,
v.
--s f 11~ v'
TYPE OF WORK 0 New Construction ODeck OPorch ~e-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition OAlteration OUtility Conne~
atllln on this application IS to the best of my knowledge true and correct. I also certify that I am the owner or authorlze,l agent for the
to all existmg state and local laws and will proceed in accordance with submItted plans I am aware that the buildmg
hereby agree that the City official or a designee may enter upon the property to perform needed msp tHln'
;)tJS f.(7 ;) 6() h 'dg
Contractor's License No.
CODE: DI.R.C. DI.B.c.
Type of Construction:
Occupancy Group: A B
Division:
o Misc.
I
E
II
F
1
III
H
2
IV V
I M
3 4
A
R
5
B
S
U
PROJECT COST /V ALUE $
(excluding land)
x
Park Support Fee
SAC
#
#
Permit Fee
$
$
$
$
$
$
I $
$
Builder's Deposit
Other
Plan Check Fee
Water Meter Size 5/8"; 1";
Pressure Reducer
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer/Water Connection Fee
#
#
Water Tower Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
This Application Becomes Y OUT Building Permit When Approved
Buildlll!! Oftieial
Date
7tJt/(/
$
$
$
$
$
$
$
$
$
-
ThIS IS to certlfy that the request in thl! above applicatIon and accompanYlOg documents is in accordance with the City Zoning Ordinance and may proceed as requested. ThiS document
when signed by the City Planner constitutes a temporary Certificate of Zomng complrance and alluws cunstructIon to commence Before uccupancy, a CCltltieate of Occupancy must be
issued
Special Conditions, if any
Planning Director
Date
24 hour noticc for all inspections (952) 447-9850. fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372