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PR,O ~ la. CITY OF PRIOR LAKE BUILDING PERMIT,
~ TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
\1)~~
Q: d1-v-J~1Cd
C OLq.+ 5 E
/2.'3 I <'6(0
Date Rec' d
White
Pink
'Yellow
/1/15/07
I PERMIT NO. () 7 -I CI 7S-1
File
City
Applicant
ZONING (office use)
LEGAL DESCRIPTION (otTice use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
\N; III' (.( 11'-'- -t- .s lAL 1/ ~
l-'3iS- Y2; d~lNOJd
a~e~'
[~H u.f- 5 ~
(Address)
(Phone)
t1 ~-2 -1~ ~--13D g
BUILDER. I
(Company Name) W ltt1-w Vj 1'- k YC {~ t1Jf>,.-h i' f c. i-~
(Contact Name) 1L-tL"'.(...4-
(Address) r (p Lf I ft~ /1'1<-/ /rvl- N.
(Phone)
(Phone)
~s-I- LJ6 'l- Y 3Z0
e-Siding OLower Level Finish 0 Fireplace
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing
OAddition OAlteration o Utility Connection
CODE: .IDI.R.C, DI.B,c, o Misc.
Type of ConstnIction: I II III IV V A B PROJECT COST /V ALUE $ _1'212 rD-
Occupancy Group: A B E 0 H I M R S U .
Division: 2 3 4 5 (excluding land)
I hereby certity that I have hlrmshed mformallon on this applicatIOn which IS to the best of my knowledge true and correct. I also certlty that I am the owner or authorized agent tlll the
clhllvl'-mcntw!1cd property and that ,Ill construction will conform to all eXIstmg state and local laws and will proceed in accordance with submIttcd plans. I am aware that the buildmg
~.ticial can revok~e:ml~ I'll! J:'O~rthermore. I hereby agree that the City officiall'1.. ~~2e~ m2' ~te~ ~on thc propel1y to pertl1rm needed ;;S/c~l! 0 7
r SIgnature -- Contractor's License No Date
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
~
$
$
$
~:
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
I This Application Become~ Your Building Permit When Approved
~ ~[)A-- / ( /1 ~/CJ 7
I Building Ufficial I Date
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
\Vater Tower Fee # $
Builder's Deposit I $
Other $
TOTAL DUE $ 7(.".00
Paid
Date
l~;;;/:7
~;"~,
55"02-'-1
ThiS IS to certify that the requl'st In the abuvl' applIcatiOn and accompanYing documents is 1I1 accordance with the City Zoning Ordinancl' and may pn)cl'cd as requested ThiS document
when Signed by the Clly Planner ClJllstIlutes a temporary Certlticate of Zonmg compltance anel allows constructIOn 10 commence. Befllle llCcupancy, a CerIlticate of Occupancy must be
Isslled
Planning Director
Special Conelitions, if any
Date
24 hour notice for all inspections (952) ....7-9850. fax (952) ..47-..2..5
4646 Dakota Street Prior Lake. MN 55372