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89:88
C I TV OF PF: I OF: Lf=:I\<E
9524474245
P.81/01
Date Rec' d
CITY OF PRIOR LAKE BUILDING PERl\1IT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
ItA-IL 1Uf=-
5bL/1
(lE/JAfJU(1of)
LEGAL DESCRIPTION (office use OnlY). () I I
LOT I BLOCK ADDITION~~C
I whil. fil. I PERMIT NO /J I
~ ;~~I~w ~~I:lie.nl . 0,3- '7' g f?
ZONING (office u~l
PIU} t) - .~/t/--, 03 5' -
OWNER
(Name) Q HAD-j-
(Address) 5' b Lj !
/11 fil2~/~ TAG/. FElL.)
{lE {l fI Lu)!-b fJ It-It! L
BUILDER A J ,/J .. & - I~i'
(Name) IvotTff ('EJJ T1!f; L I U'F:j!5j ) It' .
(Contact Name) LAP tv (filAT?
,
(Address) 790/ (JAJ() H(/C;1JUE ;1.JbtT/r
TYPE OF WORK
o New Coos!:l'l.lcti\'ln
ODcck
OLower Level Finish
o Fireplace
PROJECT COST IV ALU:e (uI',;luding land) S / 5 ~~ J
OAddition
OUtility Connection
q /) ") /, ::.< C.l7j II
(Phone) 5 .x - <.?(:J ) ~ if/::/
/LJE
(Phone) '-7$3- 5 31 -~/ h f
(Phone)
(i)EUJ jJOf/F (j7 fU S;;;'y;)
OPorch
o Re.Roofing
DAlteration
[gft(.Siding
I hereby certify chat I have furnished inronnation on this application which is to the best of my knowledge lTUe andcolTCct. I also certify that I am the owner or
authorized agertt for the above-mentioned property and that all constl'tlction wiII conform to all existing sute ami locallaw$ and will proceed in accordance with
submitted plans. I am aware that me building official can revoke this permit tor just cause. Furthermore, I hereby agree that the tit}' official or a designee may
enter u on [ property to p~ 7eded.~ctions.
X i Ct/V ..' CUJ.J) 8f (j{) I')iv 5 9 / f I 7 IF! / O~
19l1ature Contractor's License No. Date
Perrnit Fee $
PI,n Chttk Fee 11
State Surcharge $
P~~~ S
Flumbing Pennit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Oas Fireplace ?ennit Fee $
This Application Becomes Your Building Permit When Approved
Building Official
O~te
This Is 10 ~ify lhallhe f~qu.sl in the at>ov~ "pplication 31'1(l a~ompanylng (locuments l. ill 3Ccordance wIth the City Zoning Ordinance and may proceed as requested, This document
I ~.'" .,,.., 0, ~, C1~ ,"",U 'M"M... "m"""" e'""a" or '""'" -'"'' ,., ",ow. ,...""",,, "rom"""". .,r", ''''''.'''' . <'"';0''' or 0,,,,..,,, ""'" '"
~.u,d.
Planning Director n~,.. TOTAL P. 01
Park Support Fee
SAC
# S
# $
s
S
" $
# $
S
S
$ 76.---''
tt;~jPtgv iJtlf51
J
Water Meter Size 518"; I"~;
Pressure R.educer
City SAC and WAC
Water Tower Fee
Builder's Deposit
Other
TOT At DUE
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