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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
,::)- :::O-(J 2-
11/ t.~ 00 LJ t/ c.-le... .oK-.
I. White File [PERMIT NO J]
i ;~~l~w ;~~icant . U 2 -0 {p 2
ZONING (office use)
LEGAL DESCRlPTION (office use only)
LOT 8 BLOCK I ADDITION
PULJ
-r7 / E -"? /'i?-O
/rrc' ""/1 LUS -.:>
PID 2-5-337- aOb- 0
OWNER
(Name)
f2-.,
C,,/t:I"J
J~~=t:)N
(Phone) <:"1C:.::;2 - 2..21 ['-L ?J?3t:" ~
(Address)
BUILDER
(Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK
o New Construction
eck
o Porch
OAddition
ORe-Roofing
ORe,Siding
OLower Level Finish
o Fireplace
OAlteration
OUtility Connection
o Misc.
I b'reby emlY <h" I bov, fumj,bal ffiforomtion on <hi, 'ppIi"tion w!tioh i, to <he b", of my lmowlodgo On" "'" ro_, I "" emlY <h" I '10 <he own" m
,"<ho""" 'gen, fm <he "'''''-montio''''' prep,,", "d <h" "I "''''-on will roofunn '" "I exi',,"g "", "d IoOa/ I,,,, "d will pro"'d in '=td"", wi<h
''''''''ilkd pi"" I '10 'wore <h" <he bmld>ng oIIid,1 = ""'''' <hi, ponni, fut i." """, Fm<honnore, I b'reby """ <h" <he crty oIIid" m, d"i",,, m,y
enter upon the prope 0 Mform neede . pe '0 s. _ ~
X / :' / -' , , 2:Jh:J
SIgnature Contractor's License No. [Yate ~
PROJECT COST/VAL UE (excluding land) $
Permit Valuation ).
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
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 $ / 5_ 2- G
~yrt ~~/Or
1
Your Building Permit When Approved
5~()-oL
Date
[paid /li' 2- b
_Date ~_-.70 -02-
Th" " 00 = <h" <h, ","m m <h, ."',,, 'ppli~,,, "'" 'tto_,i" ""ru~,. " "'tt_~ ""h <h, City Z'run, ,,",,","re "'" m" ,"""d ~ ""0"" Thi> dorum""
"I", ",wd '" <h, C'~ P"",,, '",""M,,, , ""'"".,, C""",,, .f Zo'm, ro""limre md .nom ~"ructi" "oom~o~, B,,,,,, ocoo,moy, , C""".. of O=,moy "'." '"
issued.
Planning Director
Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
'"
PRIOR LAKE
INSPECTION
RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS .3/ (p 0 WOOD Ou Vc-
TYPE OF WORK Oe(7~
USE OF BUILDING IZGJ #/K:-
,
PERMIT NO. 02 -o(PZ-1 DATE ISSUED 5-30 _ 0"2-
BUILDER /l,/E-LSON PHONE #
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DA E
FINAL
Call between 8:00 and 9:00 A.M. for all ins
FOR ALL INSPECTIONS (952) 447-98
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