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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
at bottom)
LIJ\)t)~V '~vJ &i'
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
OWNER
(Name)
(Address)
Date Rec'd
While
Pink
Yellow
I PERMIT NO.O~ - ~6 71
File
City
Applicant
ZONING (office use)
EsI-
~ pmdS - JC}Lj- @-/
o
(Phone)
1s) --r})..~ ,}J) ')
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch Me-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition OAlteration o Utility Conne~
CODE: DI.R.C. DI.B.c.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
F
1
III
H
2
IV V
I M
3 4
o Mise.
A
R
5
B
S
PROJECT COST IV ALUE
(excluding land)
$
U
I hereby certify that I have furnIshed rnfmmation 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 t"r the
above-mentIoned pr crry and that al llnstruction WIll conform to all existing state and local laws and will proceed in accordance with submItted plans. I am aware that the building
official can revok > : permIt for JU use Furthermore, I hereby agree that the CIty official or a designee may enter upon the propelty to perform needed nspectlons. ?\ { _
X -G~
Contractor's License No.
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
8uildlllg Ofliclal
Date
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 $ ~0_ --
'7~:;-0 I ~~c~OSf~
Paid
Date
ThiS IS to certify that the request In the above applicallon and accompanYing documents is In 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 Certlticate of Occupancy must be
issued
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372