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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
<!-If). (J G
I White File I PERMIT NO ~
2. Pink Cily . 0(, (.i Z . ~
) Yellow Appliam _
ZONING (office use)
u~ C-+or~ ~
Cu..rIJe......
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID 2- \.- . 3 2 Z - tit _ (';
OWNER
(Name)
(Address)
BUll..DER
(Company Name)
(Contact Name)
(Address)
(Phone) Q69. - 0l6l~-61d.1
u..r v e...
~~.
(Phone)~/, 4.~1.qO/6
TYPE OF WORK 0 New Construction o Deck o Porch ORe-Roofing I';l!Re-Siding OLower Level Fimsh 0 Fireplace
OAddition OAlteration OUtility Connection 0 Misc. r-
CODE: OI.R.C. OI.B.C. PROJECT COST /V ALUE $ J 4Jom. a:>
Type of Construction: I II m IV V A B (excluding land)
Occupancy Group: A B E F H I M R S U
Division: 1 2 3 4 5
I have furnished information 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
ro rty and t I all nstmetion will conform to all existing state and local laws and will proceed in accordance with submiued plans. I am aware that the buildmg
this per J st ca se. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed mspectians.
~0.330 1{P~ I..l/O 'Ofp
Contractor's License No. Date
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Pennit When Approved
Buildim! allicinl
Dnte
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 IS 10 certify thatthc request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requl'Sled. This document
wh ed y the City Planner conSl1lutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
~
Planning Director
Date Special Conditions, if any
24 hour notice for all inspections (9!12) 447-98!1O. fax (9!12) 447424!1
16200 Eagle Creek Avenue Prior Lake, MN 55372
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