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Date Rec' d
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
~n~.~.:~~_ 56
White
Pink
Yellow
I PERMIT NO.
0".08ee
File
City
Applicalll
ZONING (office use)
-:py~{5Y ~N ffi'b 7J-
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
j&:R ~~~=:J::::;;
(Address) U (h;<- 5-e
(Phone) -!dLf7- 4$1
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch
OAddition OAlteration o Utility Con
e-Roofing
CtJ n
ORe-Siding
OLower Level Fimsh
o Fireplace
CODE: DI.R.C. DI.B.c. o Mise.
'le of Construction: I II III IV V A B PROJECT COST IV ALUE $
:upancy Group: A B E F H I M R S U (excluding land)
uivision: 1 2 3 4 5
1 hereby certify that I have hlfnishcd Information on this application which IS to the best of my knowledge true and correct I also certify that I am the owner or authonzed agent for the
Jbow-mentlOned property and that all constructIOn will conform to all eXlst1l1g state and local laws and will procced in accordance with submitted plans. I am Jw,ue that the buildmg
~tjClal C~~J5k~~1l~.'~1 ~It [~12:de ~l~ hmby agl ee that the City otficlal or a deSignee may enter upon the pJOpeny to pCI tor m ~]I:}~7o(e
S~e Contractor's License No Date
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
I Penalty $
I Plumbing Permit Fee $
~echanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
Buildlllg Ulflcial
Datc
Park Support Fee
SAC
#
#
Water Meter Size 5/8"; 1";
Pressure Reducer
Sewer/Water Connection Fee #
Water Tower Fee #
Builder's Deposit
Other
TOTAL DUE
IS to certify that the request in the above applicatlOl1 and ilccompanymg documents IS 111 accordance WIth the City Zoning Ordinance and may proceed as requested. ThiS document
..cn signed by the City Plannel constitutes a tcmporalY Certiticate of ZOnIng comphance and allows constructIOn to commence. Before occupancy, a CertIficate of Occupancy must be
isslled
Planning Director
Special Conditions, if any
Date
24 hOllr notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372