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Date Rec' d
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
c!-il ~I
LEGAL DESCRIPTION (office use only)
1. White File I PERMIT NO
2 Pink City . t:8 r~ r02
3, Yellow Applicant , f-{..,) LZ;;;J
ZONING (office use)
LOT
BLOCK
ADDITION
PID
oWNER I. Z. f!.' }/
(Name)~ ,I;JIY2. /J1lj,')A/ .
(Address) L/L/L/Cf;Jd 0/.mll/7 / P ~/
(phone)
C15d -c/~5' -1/73')
BlJll,DER ~ .
(Company Name) tl
7/)
(Contact Name) V
(Address) [..?
TYPE OF WORK 0 New Construction ODeck OPorch Re-Roofmg
OAddition OAlteration OUtility Connection
CODE: fA.R.C. OI.B.C. 0 Mise:
Type of ~tmction: I II ill IV V A B
Occupancy Group: A B E F HIM R S U
Division: I 2 3 4 5
(phone)
(phone)
IP(J -P~-?- S-6~
Q.5:;;-7/S-7dJ&'
ORe-Siding OLower Level Finish
o Fireplace
PROJECT COST/VALUE $
(excluding land)
1J.d~1
,./
<.;..-
I hereby certifY 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 prope and that all co will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke this rmit for .it'st c se. ore, I hereby agree that the city official or a designee may e~ter u~on ~e property to perform needed inspe .ons. 0-
X . /tJ? D ~ Q ~ 0
Contractor's License No. Date
Permit Valuation 2<::;~O" --
Permit Fee $ "1 4~ ~ <)
Plan Check Fee $
State Surcharge $ \- l,'<:::::
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
oved
Park Support Fee # $
SAC # $
Water Meter SizeS/8"; 1"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ '(V? ..-
\ Paid
Date
( --
/C>(Z-( ~
\ ReceiPtN~lPbc07
By fJ.
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. This 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.
Planning Director
Date
24 bour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
Special Conditions, if any