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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please
ADDRESS
n at bottom)
{!/1/t/f.}t-C WOOD L-I1Nb
/~/t;S-
Date Rec' d
ft,,506
I White
Pink
Yellow
I PERMIT NO. O(p. 0 +741
File
City
Applicant
ZONING (officc use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
Ii
OWNER
(Name)
G ~~~/ J
0o/JA..- It
./
(Address)
(Phone)
9S-J.. Yf~- 9/.1'7
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch Re-Roofing ORe-Siding OLower Level FinIsh 0 Fireplace
OAddition OAlteration OUtility Conn tl n
CODE: OLR.C. OLB.C. o Mise
Type of Constmetion: I II III IV V A B PROJECT COST /V ALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hcrcby ccrtiIY that I have nlrmshed mfmmatJon on this appllcatJOn which is to the best of my knowledge true and correct. I also certlIY that I am the owner or authorized agent 1,,1' the
Jbove-mentlOned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans I am aware that the building
official can revoke this permit for Just cause Further ore. I hereby agree that the City official or a deSignee may enter upon the propeny to perform needed inspectIOns
x
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
I Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
[Jate
Buildll1!! Onicial
~i".F- 6 "
Contractor's License No, Date
Park Support Fee # $
SAC # $
Water Meter Size5/S"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $
..sZr41 4--
ThIS IS to certify that the request in the above applicatIOn and accompanymg documents is in accordance with the City Zoning Ordinance and may proceed as requested ThiS dncumcnt
when signed by the City Planner constltutcs a temporary Certificate of Zomng compliance and allows constructIOn to commence. Before occupancy, a CertifIcate "f Occupancy must 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