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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
White
Pink
Yellow
File
City
Applicant
I PERMIT NO. "S ;0 4 1 (, I
ZONING (office usc)
5t:t 4'
C r 0;) sr;:. rltd r Cil
5+~
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER (l
(Name~ ~do",
(Phone) (, S" L..) :l cU ( - 8.?4- B
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
b'.e r9r~c. ",
v
Lt7,.,.s T7' t/C h t:T.,
(Phone)
(Phone)
(6 J'I ) .) 09 - 313cJ
-
TYPE OF WORK 0 New Construction ODeck OPorch ~e-Roofing ORe-Siding OLower Level finIsh 0 Fireplace
OAddition OAlteration o Utility ConnectIon
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 ccrtity that I have hJrnished lIlfnrmation on this applicatIOn which IS to the best of my knowledge true and COHect. I also certify that I am the owner or authOrized agent for the
,Ibovc-mcntwncd property and that all construction wIll confllfm to allexist1l1g statc and local laws and will proceed 111 accordancc with submitted plans. I am aware that the build1l1g
(ltfiClal CJn revnke thiS permit fOflust CJuse Furthermore, I hereby agree that the CIty official or a deSIgnee may enter upon the property to perform needed lI1SpectlOlls
'~~ ~ ~~-- - :;Lv.f'~7~{.,o ?~S/6fl
-- Contractor's License No. -' D~te
x
Signature
Permit Valuation
Park Support Fee
SAC
#
#
Paid
Date
71~e>~
L
I ~~ceiPt ~s;t:~3 0
$
$
$
$
$
$
$
$
$
-
Permit Fee
$
$
$
$
$
$
I $ ""
$
. -z>)
Water Meter Size 5/8"; I";
Pressure Reducer
Sewer/Water Connection Fee
#
#
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
llik In!! UftiClal
ThiS IS to certlty that the request 111 the above applicatlOn and accompanY1l1g documents is in accordance with the City Zoning Ordinance and may proceed as requested ThiS document
whcn .,igned by the City Planner constItute, a temporary Certificate of Zon1l1g comphance and allows constructIOn to commence Before occupancy, a Cerllficate of Occupancy musl be
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