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cn Y OF PRIOR LAKE BUILDING PERlL_ t"
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
/2. J, I'tf'
(please
ADDRESS
\'-t
at bottom)
L\~ Lor: ~~ S,
I \Vhite File
1'1Ok (ii,
Yellow Applicant
I PERMIT NO. 08,0%7 I
I
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OPorch Re-Roofmg
DUtility Connection
o Misc:
I II ill IV V A B
E F H I M R S U
1 2 3 4 5
OWNER
(Name)
(Address)
v: --r; ~I)
\~C\.~~ Lor: ~~. 5
TYPE OF WORK
CODE: DI.R.C. DI.B.C.
Type of Constmction:
Occupancy Group: A B
Division:
(Phon,) ~~2 'i40.~L..
+? Dr L1J M1-J ?6 ~
I
&6(-73/./14":/ {7~J (6
(Phone)
(Phone)
ORe-Siding OLower Level Finish 0 Fireplace
PROJECT COST/VALUE $~( 600. '>0
(excluding land) ,
I hereby cenify that I have furnished information 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 for the
above-mentioned property a,nd that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
:fficial can r~ist for just cause. Furtbermore. I hereby agree that the city official O2 ~;:~ ~6~:;; the property to perform ;;13%;-
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
Building Official
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 $ ,~ -
Paid
Date
~~~.;-,?
~:NO
~11tJ
This is to certifY that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. TIllS document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy. a Certificate of Occupancy must be
issued.
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S,E.. Prior Lake, Minnesota 55372
Date
SpeCIal ConditIOns. If aJ1j
Planning Director