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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
8. 2.0~
File
City
Applicant
I PERMIT NO. 0(;,. O~ f~
,
ZONING (office use)
White
Pink
Yellow
/-1/ tr-L- ~~ sr SE
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name)
(Phone)
pm zr: 0/7./00. 0
(Address)
BUILDER d ,-
(Company Name) ~-L\ rO-I fL.O<O\SS (1)Us-T
(Contact Name) ,LE.-t-\ F==ILI FZ..-O io 'i:..~
(Address) 1 \cC- 0 s-r f. L
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch
OAddition OAlteration OUtility Conne
~ 12- S-q C) - SS5"e
c,C;-2..- 4'4,-1 <f332-1-l
ORe-Siding OLower Level Finish 0 Fireplace
CODE: OLR.C. OLB.C.
Type of Construction:
Occupancy Group: A II
Division:
o Misc.
I
E
II
F
1
III
H
2
IV V
I M
3 4
A
R
5
B
S U
PROJECT COST IV ALUE
(excluding land)
$
i I hereby certify that I have hlrmshed lOformatlOn 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
I above-mentIOned property and that all mnstruction w1l1 conform to all existmg state and local laws and will proceed in accordance with submitted plans I am aware that the blllldmg
I oftic;a! can revoke thIS permit for Just calise Furthermore, I hereby agree that the CIty official or a deSignee may enter upon the property to perform needed mspectHl11S
Ix ~'C h::J - CO-2- 0\0
Sign~ Contractor's License No. Date
t.J
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
I Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
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
#
#
$
$
$
$
$
$
$
$
$ '7(P-
#
#
This Application Becomes Your Building Permit When Approved
Buildlllg Official
Date
ThIS IS to certIfy that the request m the above applicatIOn and accompanymg documents is m accordance WIth the City Zoning Ordinance and may proceed as requested. ThIS document
when signed by the City Planner constItutes a temporary Certificate of Zoning compliance and allows construction to commence Before occupancy. a Certificate of Occupancy mllst be
issucd
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