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6
Date Rec' d
CITY OF PRIOR LAKE UUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please
ADDRESS
4~8+
/l1//7/"l/ /I/Ci d I ~
J. 1. (/5-
I White
Pink
,\'ello\.V
I PERMIT NO. OS. 001'-:$)
File
Clly
Applicant
ZONING (office use)
7/Z8/L-
lei
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID 7!.';-. 3>~ Z tJl 9~ ()
OWNER
(N ame)
AA~v,,~
(Phone) ~ I d <; / ,f ,. ~.:( /
C/'4;7
(Address)
BUILDER ,,- ;J
(Company Name) {/l/ / f / l../);( .
(Contact Name) /?? //t"' -<'! (/'t/'
(Address) '97 cJ C) / - t:' ~
(Phone) 7 ~3 - 5 ~/, t') ..J'" tIt!
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch e-Roofing ORe-Siding OLower Level Fimsh 0 Fireplace
OAddition OAIteration OUtility Conn tl
I hereby certify that 1 have hlrnished mformation on this application which is to the best of my knowledge true and COlTect. I also certlfy that I am the owner or authonzed agent Illl the
above-mentIOned propelTy and that all construction WIll con for to all existmg state and loeallaws and w1l1 proceed in accordance with submltted plans 1 am aware that the buildrng
olflcial can revoke thiS ermil for Just cause F .thermore, I eby agree that the CIty official or a designee may enter upon the propelty to perform needed mspectlon:
X ~ ...~ ~ 'i'd~'
ThIS IS to certify that the request in the above applicallon and accompanyrng documents IS rn accordance wilh the City Zoning Ordmance and m<lY proceed as requested Tim document
when signed by the Cily Planner Cllnslltutes a temporary Certificate of Zonmg comphance and allows construction to commence Bcfme occupancy, a Certlticate of Occupancy must he
I ,,",,"
CODE: DI.R.c. DI.B.c.
Type of Construction:
Occupancy Group: A B
Division:
IV V
I M
3 4
A
R
5
I
E
II
F
1
III
H
2
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
BuildllH! Official
Date
o Misc
B
S
U
PROJECT COST /V ALUE $
(excluding land)
Contractor's License No.
Date
Park Support Fee # $
SAC # $
Water Meter Size 5/8",1"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOT AL DUE $ '7~.() ()
Planning Director
Special Conditions, if any
Date
24 honr notice for all inspections (952) 447-9850. fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake. MN 55372