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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
at bottom)
ADDRESS
If. /{/ ;//6--1
J/v~
Date Rec' d
I (. 1# or'
White
Pink
Yellow
I PERMIT NO. tJ f. 0 111> I
File
City
Applicant
ZONING (office use)
?r6:
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
(Phone)
(Address)
BUILDER /J
(Company Name) <../0....--
(Contact Name) ~ ~
rf'.J ~J;7
;;:....1
,)) J(J~L
(Phone)
(Phone) 9~")- )7~ ~~8'
TYPE OF WORK 0 New Construction ODeck OPorch
OAddltion OAlteration o Utility Conne 1
CODE: DI.R.C. DI.B.C.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
F
I
III
H
2
IV V
I M
3 4
A
R
5
ORe-Siding OLower Level Finish 0 Fireplace
o Mise.
B
S
PROJECT COST IV ALUE
(excluding land)
$
U
I hereby certify that I have furnIshed informatIon on thIS applicatton which IS to the hest of my knowledge true and correct. I also certIfy that I am the owner or authollzed agent for the
ahove-mcnl1oned property and that all constructton will conform to all eXlstmg state and local laws and will proceed m accordance with suhmltted plans I am aware that the huildmg
;jieial can revoke 2~~5:::r Just cause ?---7 that the CIty );a>:; ~:; ; lter upon the propelty to perform;2e~7t:nscX,/
Signature Contractor's License No. Date
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
Buildltll! Olliclal
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 In the abuve applicalIon and accompanymg documents is m accordance Wllh the City Zoning Ordinance and may proceed as requcsted. ThIS document
when signed by the Clly Planner constllutes a temporaty CertIficate of ZonIng complIance and allows constructIOn to commence. Before occupancy, a CerlIticate of Occupancy must he
issued
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