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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
,. z,.{, . D to
] White
Pin!.;
Yellow
File
City
Applicant
I PERMIT NO(o -B73
(Please
ADDRESS
ZONING (office use)
tLiS
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
- -0 4!3 -Cv7 - c;
OWNER
(Name)
(Phone)
(AddressV57'0l
BUILDER ()
(Company Name) 1.../,.#-1'/\,.....1
(Contact Name) ~h
(Address) I do
c...d('f)(d.J~ro. C6.
(Phone) 76 -;j 75'S J;)7~
(Phone) 7h7 ~l~ 677,
TYPE OF WORK 0 New Construction ODeck OPorch Re-Roofing ORe-Siding OLower Level Fimsh 0 Fireplace
DAdditlon DAlteration DUtility ConnectIon
CODE: OI.R.C. OI.B.C. D Mise.
Type of Constnlction: I II III IV V A B PROJECT COST/VALVE $ c;- OCYJ.=!!--
Occupancy Group: A B E F H I M R S V -
Division: I 2 3 4 5 (excluding land)
I hereby cl'rtity that 1 have hlrnishcd Information on this applicatIOn which is to the hest of my knowledge true and correct. I also certify that I am the owner or <Iuthonzed agent for the
dbovc-mentlOned \) ty and that all nlnstructlOn will Clll1tlJrm to all exrst1l1g state and ]ocallaws and will proceed 111 accordance with submrtted plans I am aware that the buildmg
official can r' 11S crmIt Ise Furthermore, I hereby agree that the CIty official or a deSIgnee may enter upon the prOpet1y to perform needed InSpectIons
9/;'.?{o(
ate
.}() 55""507';;
Contractor's License No.
Plan Check Fee
1:-
$
$
$
$
$
$
Park Support Fee
SAC
Paid
Date
~~-
z,U. O~
# $
# $
$
$
# $
# $
I $
$
$ 7;
I~~~
Permit Valuation
Permit Fee
Water Meter Size 5/8"; I";
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
I ' 2:,
Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
Sewer & Water Permit Fee
Builder's Deposit
Other
TOTAL DUE
ThIS IS to certify that the request III the above applicatIOn and accompanYll1g documents IS III accordance with the City Zoning Ordinance and may proceed as requested Tlus document
when signed by the City Planner constltutes a temporary Certificate of Zomng compliance and allows CllnstructlOn to commence Before occupancy, a Certificate of Occupancy mllst be
issued
Planning Director
Date
24 hour notice for all inspl'ctions (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
Special Conditions, if any