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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
D,ate Rec' d
9. ~Z.o6
File
City
Applicant
I PERMIT NO. 0(, .0857
I White
Pink
Yellow
l514l W~*
t\ "oJ ~ s E...
ZONING (office use)
LEGAL DESCRIPTION (olIice use only)
LOT
ADDITION
PIDZ,}. O-rl . 00 v~ i)
BLOCK
OWNER
(Name)
(Phone)
(Address)
Jo\"'", ~\i ~ ( ~e"
(Contact Name) Ge~ UJ~~~e....r
(Address) 7a.~ ~ ai TPc 5-\- .. \ 04
BUILDER
(Company Name)
(Phone)
(Phone)
\>~~ ~'^ .
5.(- ~\ ~
95'3 ~9'a5"- '\5'~
5'6" .fa",
TYPE OF WORK 0 New Construction ODeck o Porch ORe-Roofing ORe-Siding OLower Level FinIsh 0 Fireplace
OAddition OAlteration o Utility ConnectIon
CODE: OLR.C. OLB.C.
Type of Constmction:
Occupancy Group: A B
Division:
o Mise.
IV V
I M
3 4
A
R
5
B
S U
I
E
II
F
I
III
H
2
PROJECT COST IV ALUE $
(excluding land)
I hereby certity that I have furnIshed mformatlOn on this application which lS to the hest of my knowledge true and COlTec!. I also certIfy that I am the owner or authonzed agent for the
above-mentIOned property and that all constructIOn will conform to all eXIstIng state and local laws and will proceed In accordance wIth submitted plans I am aware that the buildmg
official can r okc thIS perml r Jt . ca ' Furthcrmore, I hereby agree that the cay official or a deSIgnee may enter upon the propel1y to perform needed lnSpectHms
Ole\ a<c~a~ 'l-aa-<k
~tNO
Contractor's License No.
Park Support Fee
SAC
Permit Valuation
#
#
Permit Fee
$
$
$
$
$
$
I $
$
TOTAL DUE
Plan Check Fee
Water Meter Size 5/8"; I";
Pressure Reducer
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer/Water Connection Fee
#
#
Water Tower Fee
Builder's Deposit
Other
Sewer & Water Permit Fee
Gas Fireplace Permtt Fee
'1 ~ Ov
This Application Becomes Your Building Permit When Approved
Paid
Date
lluildlllg UfIiclal
Date
Date
$
$
$
$
$
$
$
$
$
S""l-.f '2-- z.....
ThIS IS to ccrtIfy that the requl'st 1Il the above applIcation and accompanYlllg documents is in accordance with the City Zoning Ordinance and may proceed tIS requested Thls document
when signed by the City Planner constItutes a temporary Certificate of ZOnIng compltance and allows construction t(l commence Bcfme occupancy, a CertIficate of Occupancy must be
issued
Special Conditions, if any
Planning Director
Date
24 hour notice for all inspections (9:;2) 447-911:;(), fax (9:;2) 447-424:;
4646 Dakota Street Prior Lake, MN 55372