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File
City
Applicant
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIAN
AND UTILITY CONNECTION PERMIT
170/2-
fJ~f1SI1/V'T n0100tV
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
(Phone)
(Address)
BUILDER PAT FRIEDGES CONSTR.
(Company NameL612-490-8698
(Contact Name) 21731 BENTLEY CIRCLE
(Address) JORDAN, MINNESOTA 55352
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch -Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition OAlteration OUtility Conn tJon
CODE: DI.R.C. DI.B.c.
Type of Construction:
Occupancy Group: A B
Division:
o Misc
I
E
II
F
1
III
H
2
IV
I
3
V
M
4
A
R
5
B
S U
PROJECT COST IV ALUE $
(excluding land)
1 hereby certily that 1 have furnished m!tJrmatlOn on this applicatllln which IS III the best of my knowledge true and correct. I also cerllly that I am the owner or authorized agent for the
above-mentIOned property and that all constructIOn will conform to all eXlstmg state and local laws and WIll proceed 10 accordance with submItted plans. I am aware that the build10g
ollicial can revoke thIS permIt for Just c se Fu. ermore, ereby agree that the CIty official or a deSignee may enter upon the property to pertc1lm necded 1Ospecl1ons
x
Contractor's License No.
Date
Water Tower Fee
Builder's Deposit
Other
#
#
$
$
$
$
$
$
$
$
$
Permit Valuation
Park Support Fee
#
#
Gas Fireplace Permit Fee
$
$
$
$
$
$
$
$
SAC
Permit Fee
Plan Check Fee
Water Meter Size 5/8"; 1";
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Pressure Reducer
Sewer/Water Connection Fee
Buildll1!! Otlicial
Date
By
This Application Becomes Your Building Permit When Approved
ThIS IS to certlly that the request 10 the above application and accompanY1Og documents is 10 accordance with the City loning Ordinance and may proceed as requested. ThIS document
when signed by the CHy Planner constHutes a temporalY Certificate of lon1Og compliance and allows construction III commence. Before occupancy, a Certlticate of Occupancy must be
issucd
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