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Date Rec' d
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
ADDRESS
LEGAL DESCRIPTION (office use only)
LOT (J BLOCK / ADDITION
OWNER I / II t7
(N ame) 'De'-'j V <<~ N..0 e /cK.t-
(Address) 1-1/( 1-- C-<eS
BUILDER
(Company Name) I'-tlJ ~~+
(Contact Name)
(Address) 3/3
L;v
Co (j +- -; t--'j
I Whitt:
Pink
J Yellow
[ PERMIT NO.rJfo-S031
File
City
Applicant
ZONING (office usc)
/U t~ -I--
tV
/J~ Lf7;(j~
PJqJ5- 3i4'-Oo1-~
(Phone) CIS')'" ,,". 4 0 '5 ~ b 746
!-J.E'
c.....<-.
(Phone) 76:3. q::J-7- oz,~r;;
(Phone)
---~3( G'
TYPE OF WORK 0 New Construction ODeck OPorch Re-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition OAlteration OUtility Conne tio
CODE: DI.R.c. DI.B.c.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
F
I
III
H
2
IV V
I M
3 4
A
R
5
o Mise.
B
S
U
PROJECT COST IV ALUE
(excluding land)
$
I hereby certify that I have hlrnishcd mformation on this application which IS to the best of my knowledge true and correct. I also certify that I am the owner or authOrized agent for the
above-mentIOned pro erty and 1Jt all Cllnstruction will conform to all eXlstmg state and local laws and will proceed in accordance with submitted plans I am aware that the buildmg
official can revok ' s pel or Just cause Furthermore, I hereby agree that the cIty official or a designee may enter upon the propel1y to perform needed mspectlOns
x
Signature
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
Buildlllg Oftlcial
Date
.200 (0..:>77
&-Of--Ob
Contractor's License No.
Date
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 $ riG" , ---
.
Paid
Date
1(- --
2-~q-~
I ~;ce;Pt~-ILj15'
Tim IS to certify that the request m the above applical10n and accompanymg documents is m accordance with the City Zoning Ordinance and may proceed as requested. TIllS document
when signed by the CIty Planner Clll1Sl1tutcs a temporary Certificate of Zonmg comphance and allows constmCl1on to commence Before occupancy, a Certificate of Occupancy must be
issued
Planning Director
Special Conditions, if any
Date
24 hour uoticc for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372