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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please
ADDRESS
n at bottom)
71U1 7 I b~J
1~7Z5"
Date Rec' d
'1 28. () (;,
White
Pink
Yellow
File
City
Applicant
I PERMIT NO. 0' .660;; I
~'c-
ZONING (office use)
LEGAL DESCRIPTION (ofIice use only)
LOT
BLOCK
ADDITION
OWNER
(Name)
PID L.- r 213 1-. tJ:?'- - 0
(Address)
(Phone)
~ 1-1 rJ C r.IIIJ1-b~
\
BUILDER
(Company Name)
(Contact Name)
(Address) I y '2...88'
",
..
" l-1kJ I tJ L-14 c {
(Phone) (&, /zJ 7 I ~ ~ J -:::5' j
(Phone)
4 . V. """ IV 5'51 '2. c.;
TYPE OF WORK 0 New Construction ODeck OPorch e-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition OAlteration OUtility Conne I
CODE: DI.R.C. DI.B.c.
Type of Construction:
Occupancy Group: A B
Division:
III
H
2
IV V
I M
3 4
A
R
5
I
E
II
F
I
o Mise.
B
S
U
PROJECT COST IV ALUE
(excluding land)
$
I hereby certify that 1 have hlrnished 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
above-mentIoned property and that all construction will conform to all eX1stmg state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
offiCial ca lke tlm rmlt for lust cause Furth' 'more, I hereby agree that the City official or a deSignee may enter upon the propel1y to perform needed mspe tlll11S.
x
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
I Penalty $
I Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
Buildlllg Urtlclal
Date
._---Y3c -205'1 ~"2 ~y
Contractor's License No.
Park Support Fee
SAC
#
#
$
$
$
$
$
$
$
Planning Director
Water Meter Size 5/8"; 1";
Pressure Reducer
Sewer/Water Connection Fee
#
Water Tower Fee
Builder's Deposit
Other
#
This 1S to certify that the request In the above applicatlOn and accompanymg 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 all1.1ws constructi1.1n t1.1 commence. Before occupancy, a Certificate of Occupancy must be
issued
TOTAL DUE
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
Special Conditions, if any