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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec'ct
B. Z.Z. 01,
I PERMITNO.O~,O 7~~
,
ZONING (office use)
White
Pink
Yellow
File
City
Applicant
(Please
ADDRESS
gOI/Nry
5zq
ST.
LEGAL DESCRIPTION (office use only)
PID t,.)-. 1~1. <J"".O
ADDITION
LOT
BLOCK
OWNER
(Name)
(Phone)
(Address)
I BUILDER
r (Company Name)
I
(Contact Name)
(Address)
\.-~ \,.J:Z6--\:
""\ '5"'1. 4'-\"1 ...", /.:..,.""",~
(Phone)
(Phone)
L. LC-
'_~~\-""-~.o!'CJ
J:' - -f---
~t..-r.....
TYPE OF WORK 0 New Construction ODeck OPorch Re-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition OAlteration OUtility Conn ctlO
o Mise
CODE: DI.R.C. DI.B.C.
Type of Construction:
Occupancy Group: A B
Division:
III
H
2
IV V
I M
3 4
A
R
5
B
S
I
E
II
F
I
$
PROJECT COST /V ALUE
(excluding land)
U
I hereby certify that I have furnished mformation on this applicatiOn which is to the best of my knowledge true and correct. I also certify that I am the owner or autho!lzell agent for the
above-mentiOned property and that all constructiOn will conform t all existmg state and local laws and will proceed 10 accordance with submitted plans. I am aware that the buildrng
offiCial can revoke tlm permit fLlI Just caus' Furthermore, I y agree that the CIty official or a deSignee may enter upon the propeny to perform needed mspectl<lns
<;;:(: . 1. L - c .(.,
Date
x
Contractor's License No
Signature
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 $
$
$
$
$
$
$
$
$
$
Park Support Fee
SAC
#
#
Water Meter Size 5/8"; I";
Pressure Reducer
Sewer/Water Connection Fee
#
#
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
This Application Becomes Your Building Permit When Approved
Date
BlIildlll~ Ofticlal
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. ThlS document
when signed by the City Planner constitutes a temporary Certificate of Zonmg compliance and allows construction to commence Before occupancy, a Certificate of Occupancy must be
issued
Planning Director
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
Special Conditions, if any