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Date Rec' d
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
9-/~ ()(,
I White
Pink
3 Yellow
I PERMIT NO. 0 ~. i z..+-I
File
City
Applicant
ZONING (office use)
AS{Jt!f\ A lie N E
pr;o( Lc.ke
fY11J
PrJ.fj)
5537 ;)..
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID zr 2-0 r-. O~/I 6
OWNER t)
(Name) :r" s "" "
Erdt:tA I
(Phone)
'fSJ- <('IS - q9~ L I
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
Re-Siding OLower Level Finish 0 Fireplace
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing
OAddition o Alteration OUtility Connection
CODE: DI.R.C. DI.B.c.
Type of Construction:
Occupancy Group: A B
Division:
V
M
4
A
R
5
III
H
2
IV
I
3
I
E
II
F
1
o Misc.
B
S
U
PROJECT COST IV ALUE
(excluding land)
$
I hereby certifY that I have hlrntshed mtilrmalion on this application which is to thc best of my knowledge true and correct. I also certifY that I am the owner or authonze,! agent for the
ahove-mentlOned property and that all construction wIll conform to all eXIsting state and local laws and will proceed in accordance with suhmllted plans. I am aware that thc buildmg
~Tlcial c evoke thIS pel mil for Just cause FlIlthelmOlC, I heteby agree that the City offiCial or a deSIgnee may enter upon the propelty to pel form 3 7jJ'7 ()~
Contractor's LICense No tDate
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
8uildln!! Ofticial
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 $
Tim IS to cerlify that the request m the abuve applicatIon and accompanYing documents IS In accordance with thc City Zoning Ordinance and may proceed as requested. ThIS document
when signed by the City Planner constitutes a temporary Certificate of Zonmg compliance and allows construction to commence Before occupancy, a Ccruficatc of Occupancy mllst be
issued
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372