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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and sign at bottom)
ADDRESS
I 57 tj/
HeeMOMr
. ,
LEGAL DESCRIPTION (office use only)
Date kec' d
I White
Pink
Yellow
I PERMITNO'~~l10.
File
City
Applicant
#o~
ZONING (office lIse)
t<
LOT
ADDITION
t S\.AJ) tJ (~ ~
PID
"-'2.)"1. ,,0
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OWNER ~
(Name) .-J oJ, .
L a#fi- hol(~ 7
. iI'
(Address)
ec
,--
i BUILDER
(Company Name)
(Contact Name)
(Address)
141fhn~u
(Phone) o;-? )
~vo 1~.7t.('
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a"5/
(Phone) tlr;)..
(Phone)
~~ /i/oS;
TYPE OF WORK D New Construction DDeck DPorch ~oofing ~e-Siding DLower Level FinIsh D Fireplace
DAdditIon DAlteration DUtility ConnectIon
CODE: DI.R.C. DI.B.C. DMisc
Type of Constnlction: I II III IV V A B PROJECT COST IV ALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: I 2 3 4 5
Permit Valuation
Permit Fee $
Plan Check Fce $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechamcal Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fec $
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 $ "ff. . -
-
I Paid 1.~. -t
. Date \_ 'S- 0"-
Receipt No. S-1-4~
By ill ~
ThiS IS to certify that (he 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 cnnstltutcs a temporal)' Certificate of ZOl1lng compliance and alln'v\'s construction to commence. Before occupancy, it CertifICate of Occupancy must be
IsslIed
Planning Director
Special Conditions, if any
Date
24 hour uotice for all inspections (952) ....7-985ll, fax (952) ....7-..2..5
16200 Eagle Creek Avenue Prior Lake, MN 55372