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Date Rec' d
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
e or Tint and si n at bottom)
ADDRESS
J ~t- li C~t-.~I J\{J C I V c,
I White
Pink
Yellow
File
City
Applicant
PERMIT NO. ~ - -i ~~
ZONING (office use)
LEGAL DESCRIPTION (office use only)
~-
LOT
BLOCK
ADDITION
PID
OWNER
(Name)Je>U.~5- S-t--d<SQ\[)
(Address)
BUILDER
I (Company Name) --D~~l.-\.- p
I (Contact Name) ~~ JJOfs-t tt1
(Address) '~ C
(Phone)
111--) 1 <a~ ~
(Phone)
(Phone)
bJif 7oI7})tj
5~ WI\(J
::iJ}d cA VI
TYPE OF WORK 0 New Construction ODeck OPorch f;J]Re-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition o Alteration OUtility ConnectT'on
CODE: DI.R.C. DI.B.c. o Mise
Type of Construction: I II III IV V A B t:JCJ
Occupancy Group: A B E F H I M R S U PROJECT COST IV ALUE $ % d 1)c) --:::.,
Division: 1 2 3 4 5 (excluding land)
'ormatlon 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
onstruction will conform to all eXlstmg state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
1 e Furthermore, I hereby agree that the City official ()f a deSignee may enter upon the properry to perform needed mspccttons
0~O~ 4/~/60
Contractor's License No. Date
x
'l:~Ot). -
$ 4.1'"
$
$ \.
$
I hereby certify that
above-mentIOned p~ Cl
official can revoke i
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
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 $ 1 b.. '"
~-
(, .. I
Receipt No.
By Uc4"'
Paid
Date
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 document
when signed by the City Planner constItutes a temporary Certificate of Zonmg comphancc and allows constructlOn to commence. Before occupancy, a Certificate of Occupancy must be
i.ssued
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