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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE, '
AND UTILITY CONNECTION PERMIT
Date Rec' d
II. Z, 0.0 c::,
l__~M~W:._:
IADD\-ii )..- f1Wf:T~IL-S~
I. While Fil.
2, Pink City
J Yellow Applic...
I PERMIT NO. (,. /04j
I I ZONING,__, I
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
&=~~'K~b~\ G~~
(Address) l I--Jonz.on +er~ S'~
TYPE OF WORK 0 New Construction DDeck
DAddition OAlteration
CODE: OI.R.C. OLB.C.
Type of ConstnIction:
Occupancy Group:
Diyision:
n
F
1
mIVVAB
HIM R S U
:1 3 4 5
I
A B E
(Phone) C15d.-..If '10'- C(,:d-;d--
(phone) ~-)"/(O~G~.5'
(Phone)
e.Roofing ORe-Siding
o Misc.
OLower Level Finish
o Fireplace
PROJECT COST /V ALUE
(excluding land)
s ClfJ/o /(J,.,
,
I hereby certify that I have furnished information on this application which is to the best of my knowled&e true and correct. I also certify that I am the owncr or authonzcd agcnt for the
above.menl1 property and that aU construction will conform to aU existing state and local laws and will pt'OCftd in accordance with submitted plans. I am aware that the builtling
oflkial ke is 't for just cause, Furthermore. I hereby agree that the city official or a designee may enter upon the property to perform needed mspcctions.
, ~~91q -.J '~/~-oc
Contractor's License No. Date
x
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 Permit When Approved
Date
Buildin2 Official
Park Support Fee # $ I
SAC # $
Water Meter Size 5/S"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ 7(, -
I Paid
Date
~-
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ThIS IS to certify that the request in the above application and accompanying doaImen15 is in acconlance with the City Zoning Ordinance and may proceed as rrqucstcd. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence, Before occupancy. a ClTtificate of Occupancy must be
issued
Planning Director
Date Special Conditiona, if III)'
24 hour notice for all inspections (952) 447-98!1l1. fall (952) 447-4245
16200 Eagle Creek Avenue Prior Lake. MN 55372