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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ,Z; /. / /
AND UTILITY CONNECTION PERMIT
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I. white File PERMIT NO /
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4,„,„E 2. Pink City r� /Z g /
3 Yellow Applicant
(Please type or print and sign at bottom) ZONING (office use)
ADDRESS , i i 0 PCB /✓D ✓/ 6-, „ / -- nX-c
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER /1,E.�. fill. / ✓&/ (Phone) • �Z /7 � Z6�
(Name)
(Address) gf}
BUILDER (Phone)
(Company Name)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ['Deck ❑Porch ❑Re- Roofing ❑Re- Siding Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection tf- /2'15 -
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B PROJECT COST /VALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have punished information on this application which is to the best of my knowledge true and correct. 1 also certify that I am the owner or authorized agent for the
above - mentioned property and •,t 11 construction will • /rm all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke this per) • t c e Ft ther • - •y agree that the city official or a designee may enter upon the property to perform needed inspections.
/ i /% .I. .�� /' —Z—)
X Contractor's License No.
Date
Si: re
Permit Valuation
4-1 O U 0 V 0 Park Support Fee # $
Permit Fee SAC # $
Plan Check Fee
$ Water Meter Size 5/8 "; 1 "; $
State Surcharge
$ 2, _ CO Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbin g Permit Fee S ^-S�
$ /L Water Tower Fee # $
7 $
Mechanical Permit Fee $ Builder's Deposit
Sewer & Water Permit Fee $
Other $
Gas Fireplace Permit Fee $ -------
TOTAL DUE $ MO 75-
/
This Application Becomes Your Building Permit When Approved Paid 6,&v ei 1 I B
Receipt No. 7
Date /d- - - 1 I y � I
Building Official Date
This as 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 Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372
Residential Building Permit Checklist
Basement Finish InteriorAlteration to Single Family Homes
BY: Date: /
Building Permit # // / 2„.6 PID: Zoning:
Site Address */O (aN/)Vitl"/ --��
Legal: L B Subdivision:
Existing Structure: YES or NO
CONFORMS TO ZONING YES NO
ORDINANCE
YES NO
Ls this an expansion of the existing footprint or Refer to Planning
building height?
Is the property located within the flood plain? Refer to Planning
Does the alteration include any additional kitchens? Refer to Planning
Does the proposed alteration include any outside Refer to Planning
entrances other than patio doors?
Is the proposed use of the finished space or Refer to Planning
alteration for anything other than a normal single
family home (office, group home, day care, etc.)?
THIS CHECKLIST MUST BE COMPLETED AND INCLUDED IN THE BUILDING PERMIT FILE TO
MAINTAIN A RECORD OF THE REVIEW.
L: \TEMPLATE\ALTCHCK.DOC