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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE. .
AND UTILITY CONNECflON PERMIT
Date Rec'd
&_ 2--1. 01
~-<<~-=
I ADy~ --15 -. V+ CtIlLI e-
L While File I I
~. ~Iow ~ PERMIT NO. 61. 0 5'$~
I ZONmG,__. I
LEGAL DESCIUPTlON (office use only)
LOT
BLOCK
ADDmON
(phone) 9~2 -'/L! 1- ~ 7A
PID z.s-. 14{ 07_3 0
~'C~A'eDQ. ~~ 'S+e.rJ h.0-ff
I);.. \. \
(Address) SPrmG-
o Firq)lace
TYPE OF WORK 0 New Construction ODeck OPorch Re.Roofing ORe-SidiIIg
OAddition OAlteration OUtility Connection 0 Misc.
. CODE: OJ.R.C. OJ.B.C.
Type of Construction: I
Occupancy Group: A B E
Dmsion:
n mIVVAB
F HI MRSU
1 2 3 4 5
~f36
~
PROJECT COST/V ALUE S
(exdudiJIIlancl)
I bm:by certify that I have IimIished informauOll on this applicltioa whidl is 10 the best of my knowJedtlr tIW and correc!. I also certify tbat I am the owner I" autllorizcd apt fur the
above-menboned property and thaI aU.~. _..oil __....... _.............. -... -- - 1- -.......-
:-~"-1-~ -s;._.....'"'-~.~7j'W;7....-..-1)~~
Signature ContnIdor's Licetue No. Date
Permit Valuation
Permit Fee S
Plan Check Fee S
State Surcharge S
Penalty S
Plumbing Permit Fee S
Mechanical Permit Fee S
Sewer & Water Permit Fee S
Gas Fireplace Permit Fee S
This Application Becomes Y-1JuihUnI Penait WlIen AppI'oYd
Building Official
Date
ParltSupportFee # S
SAC # S
Water Meter Size 5/8"; 1"; S
Pressure Reducer S
Sewer/Water Connection Fee # S
Water Tower Fee # S
Builder's Deposit S
Other S
TOTAL DUE S
nus is to certify !bat the reqUCSl in the above application Ind accompanyinJ documents is in acc:ordaIIce with the City Zoainc Ordiaana IIId -y proceed as requcsled. This d(lCUIllCllI
whm sipc:d by the City Planner constitutes a tempODrY CertificaIe of Zoaina compIiancc and allows constructioIIlO c:ommmcc. Ildocc occupancy. a Cc:rtificate of Occ:upancy must be
issued
PIamIina DireeIOr
Dare SpceW Coaditioaa, if any
:z4 hoar aotice for alllDSpectiolls (951) "7-98SO. fax (951) "7-4:z4!1
16200 Eagle Creek Avenue Prior Lake. MN 55372