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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
,-/ ,
Il\d-. ~ ~ r- 1S,~v-' V\0<<"-
tOT 1... BLOCK \
ADDITION
(Address)
D \~ n-e.l \1\ft\ \S
\ '-- \ J-.- ~ ::,
BUILDER
(Company Name)
(Contact Name)
(Address)
/' T(.4..
\,e;:> An)
Date Rcc' d
I. White
2 P;nk
] YeUow
filr
City
Applic_nl
I PERMIT NO. ~ "'-''1U
~,~-
ZONING (office use)
lZ-- ,
1.
4-a:J,-- -0
1}..JO ~
(:};dJ)'u)'.%13J,(Phone) q~ ~~ID -Sgr)b
?n \\\(" \A\r c
(Phone)
(Phone)
TYPE OF WORK D New Construction DUeck DPorch 'fflRe-Roofing
DAddition DAlteration DUtility ConnelJbn 0 Misc.
CODE: OI.R.C. OI.D.C.
Type of ConstTuction:
Occupancy Group: A B
Division:
I
E
II
F
I
ill IV V A
HIM R
2 3 4 5
ORe-Siding OLower Level Finish 0 Fireplace
B
S U
PROJECT COST /V ALUE
(excluding land)
s _'3 J r:J:x)
I hc-reby certify that I have Furnished information on this application which is to the best of my knowledge tme and correct. I also cmiry that I am the owner or authori!ed agent for the
above-mentioned property and that aU construction will conform to all cxisting state and local laws and will proceed in accordance with submitted plans. I am aware that the building
officia\can revokec this permit for just cause. Fu ermore. I hereby agree that the city official or a de,ignee may enter upon the property to perform needed Inspections.
X \") ~...'
Signature Contractor's License No. Dale
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
$
$
$
$
$
$
$
$
Sewer & Waler Permit Fee
Gas Fireplace Permit Fee
1-<)"::>0. -
(1,
\. 1--S-
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
I Paid
Date
"l~';
sf .., (qp
#
#
$
$
$
$
S
$
$
$
$ 1"'-
#
#
I Receipt No, C; 2,.UP3
By ~ "",
ThIs is to cmify that the r"'luest in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may procerd as requested. Thil document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occllpaney,l Certificate of Occuplney mUll be
llsued
Planning Director
Date Special Conditions, if any
24 hOllr nolire for all inspections (9~2) 447-9850. fax (952) 447-414!i
16200 Eagle Creek Avenue Prior Lake, MN 55372