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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
ADDRESS
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name)
(Address)
BUILDER ~ '
I (Company Name). . l ~ n
(Contact Name)_ I
(Address)
Date Rec' d
1 White
Pink
Yellow
I PERMIT NO. CJ(.- /lq1
File
City
Applicant
ZONING (office use)
G,3)
{J {;~v/ (}Cl Ie
I
E
II
F
1
III
H
2
IV V
I M
3 4
PID
-c)
(Phone)
95;2jf<f~ -t, ~.:JS
f6-??76l
?57'.l-
TYPE OF WORK 0 New Construction ODeck o Porch
DAdditlOn DAlteration o Utility Conn cu
CODE: OLR.C. OLB.C.
Type of Construction:
Occupancy Group: A B
Division:
ORe-Siding OLower Level Finish 0 Fireplace
o Misc.
A
R
5
B
S
PROJECT COST IV ALUE
(excluding land)
$
U
I hereby certity that I have furnished mformation on this applical10n which is to the best of my knowledge true and correct. I also certity that I am the owner or authorized agent for the
Jbove-mentlOned property and th all construction Will conform to all existmg state and local laws and will proceed in accordance with submitted plans. I am aware that the bUlldmg
official can r' oke this permit te) sause Fu .therm r I hereby agree that the City official or a deSignee may enter upon the propelty to perform needed inspectIons
" _~o'fK~-3_5' /J~~~ 30j
Signature Contractor's License No. ~ Date'
x
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
Huildlllg O/licial
Date
o~
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit I $
Other $
TOTAL DUE $ /7~, .-
l~ ::
~ ,>$'!- -b
I ~;ro :5 /8'(j
Paid
Date
ThIS IS to certify that the request In the above applicatIOn and accompanymg documents is m accordance WIth the City Zoning Ordinance and may proceed as requested ThIS dllcument
when signed by the City Planner constItutes a temporary Certificate of Zonlllg compliance and allows construction to commence Before occupancy, a Certificate of Occupancy must be
isslled
Planning Director
Special Conditions. if any
Date
24 hour notice for all inspections (9:;2) 447-98:;0, fax (9:;2) 447-424:;
16200 Eagle Creek Avenue Prior Lake, MN 55372