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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
7.1.01
File
City
Applicant
PERMIT NO. OtJ . U 1-.fA::,
1 White
Pink
Yellow
n at bottom)
1& )7-)
1~ J tA C{ J Ot'\C{
01~ cl1 0 rcle 5W
ZONING (office lIse)
LEGAL DESCRIPTION (office use only)
LOT BLOCK
ADDITION
PID
-1"'5 tvv uJ
(Phone)
0/)
3/10
I
I
nf?ll
I
OWNER
(Name) tv' t:.-
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch Re-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddlt!on OAlteration o Utility Conne ton
CODE: OI.R.C. OI.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
I hereby certify that I have hlrI1lshcd Infilrmattnn on this applicJtion which is to the best of my knowledge true and correct. I alsll certify that I am the owner Dr authorIzed agent for the
ahove-mentllll1ed property and that aU_.c . )rm to all eXIstmg state and local laws and will proceed in accordance with submitted plans 1 (1m aware that the ouildmg
lll1inal can revoke t t<.. -. agree that the City official or a desIgnee may enter upon the prope11y to pertiJrm needed tnsp 'CHons
x
Contractor's License No.
Park Support Fee
SAC
#
#
Permit Fee
$
$
$
$
$
$
~:
TOTAL DUE
Plan Check Fee
Water Meter Size 5/8"; I";
Pressure Reducer
Sewer/Water Connection Fec
#
#
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
Water Tower Fee
Builder's Deposit
Other
This Application Becomes Your Building Permit When Approved
Iluildlllg Unlclal
Datc
$
$
$
$
$
$
$
$
$
Tins IS to certify that the requcst 111 the above applicatIOn and accompanymg documents is in accordance with the City Zoning Ordinance and may proceed as requested ThiS document
v.'hen signed hy the CIty PLlnncr Cimstltutes J temporary Certificate of Zon1l1g complIance and alluws cUl1struction to commence. Before occupancy, a Certificate of Occupancy must he
i.\Slll'd
Planning Director
Date
24 hour notice for all inspeetious (952) 447-985n, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
Special Conditions. if any