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°� 11R10+ Short -Term Rental Housing Permit <br />�; `,: <br />FOR CHANGE OF USE TO VACATION RENTAL HOME <br />Please complete in ink - - Include fees with application <br />Annual Fee on Fee Schedule as posted at www.CityofPriorLake.com <br />SKETCH OF PROPERTY SHOWING ALL STRUCTURES, DRIVEWAY, PARKING SPACES, SHORELINE, PROPERTY LINES <br />411cL -AILI A <br />I hereby certify that I am the owner or authorized agent of the owner of the described property, that the information <br />provided herewith is correct and representative of the existing conditions on the property. I understand that falsifications <br />of this application or any attachments thereto will serve to make this application and any subsequent permit invalid. <br />Owner Signature /s/ <br />Agent Signature /s/ <br />Permit # <br />Permit Expiration <br />Remarks <br />Date <br />Date <br />OFFICE USE ONLY <br />Fee Paid <br />Property Postings Verified <br />Receipt # <br />Approved by <br />Please submit to City of Prior Lake at 4646 Dakota Street SE, Prior Lake, MN 55372 or email to Dstefanisko@cityofpriorlake.com <br />