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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY~ERTIFICATE OF ZONING COMPLIANCE
OltSSe. .fk rl._~D WILITY CONNECTION PERMIT
, d~:> I~" II(j I White Fde
V/ II' {l /J {\.A Pink City
~ /:jcce Yellow Apphcant
Date Rec' d
/0" S-, () 7
I PERMIT NO. tJ 71 ay(;. z-\
ZONING (office use)
/7J IiI
.553'72
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
(Phone)
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
:r-/lI.Z)(i.s TP ES
TYPE OF WORK 0 New Construction ODeck OPorch
DAddition o Alteration o Utility Conn
CODE: OI.R.C. OI.B.C.
Type of Constntction:
Occupancy Group: A B
Division:
I
E
II
F
I
III
H
2
IV V
I M
3 4
A
R
5
'ES
(Phone) <fS(J- 232- 54/3
(Phone) ~5/- 'f9fJ' 1/9tJ
/l'J AI.
ORe-Siding OLower Level Fimsh 0 FIreplace
o Mise
B
S U
PROJECT COST IV ALUE
(excluding land)
$
I hereby certity that I have lurtltshed mformatllln on thiS application which IS to the best of my knowledge true and correct I also certify that I am the owner or authortzed agent f,,, the
"bove-mentloned property and that all eonstructHm will confiJrm to all eXlStmg state and local laws and will proceed in accordance with submitted plans I am aware that the blllldmg
"tr'Clal can revoke tIllS permit for Just cause Furthermore, I hereby agree that the City official or a deSignee may enter upon the propel1y to perl(yrm needed mspectHH1S
X 1f~4<-~ ~"~~~ ~~':~'LiIT""N" /fJ/~?f?
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
I Penalty $
Plumbing Permit Fee $
Mechamcal Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace PermIt Fee $
This Application Becomes Your Building Permit When Approved
Huildlng Uff,e,al
Date
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; 1"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $
TIllS IS to eertlly that the request m the above application and accompanymg dllCuments IS m accordance With the City Zoning Ordmance and may proceed as requested TIllS document
when Signed by the City Planner constitutes a tempor,uy Certificate of Zonmg compliance and allows construction to commence. Bcfme occupancy, a Certllicate "f Occupancy must be
isslIed
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372