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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE r Ii;;'
AND UTILITY CONNECTION PERMIT /6/ $~ (0 "
I ~i~~e ~:~y I PERMIT NO. ~ / -oq flit!
Yellow Applicant , U CP I Q
~~
LEGAL DESCRIPTION (office lIse only)
LOT 5 BLOCK ADDITION
ZONING (office lIse)
R-
M~~~
PID,)5 -;:1./;0 -D~~
\ ~~~R CHucK
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address) SbY/J
No JJKE
I
(Phone)
p
(Phone) 6 f). " 7/)(--6)'1
(Phone)
(JJN
TYPE OF WORK 0 New Construction ODeck OPorch ).(l'Re-Roofmg ORe-Siding OLower Level FinIsh 0 Fireplace
OAdditlOn OAlteration OUtility ConnectIon
CODE: ~.R.C. OI.B.C.
Type of &stroction:
Occupancy Group: A B
Division:
I
E
II
F
I
III
H
2
IV V
I M
3 4
A
R
5
o Mise
B
S
$ ~$tn,tn)
U
PROJECT COST IV ALUE
(excluding land)
I hereby certIfy that I have hllnlshed mformatHln on this applicatHl11 which IS to the best of my knowledge trlle and mITeet I also certify that I am the owner or authOrized agent tllr the
above-mentIOned property and that all nlnstruction w1l1 confnrm to allexlstmg state and local laws and will proceed in accordance with submitted plans I am aware that the huildmg
(lfticial can IT oke thiS permit for JlIst cause Furthermore, I hereby agree that the CIty official or a deSignee may enter upon the property to perform needed mspcctHlI1S
X 19~7 -LD-30~~
Contractor's License No. Date
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
-
,Z~
Gas Fireplace Permit Fee
Sewer & Water Permit Fee
This Application Becomes Your Building Permit When Approved
I~~
! Buildlllg Ut'ticial
/o!r,kt,
, Dlte
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; 1"; $
Pressure Reducer $
Sewer/Water ConnectlOn Fee # $
,
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ 7l",OO
I P"id~ 3' .. "
Date 0 f"I 0 to c,.
I Receipt No. ~ 2-fI t:JK
By '1r-
ThlS IS to certify th,lt the request 1I1 the above application and accompanYlOg documents is 111 accordance with the City Zoning Ordinance and may prnceed as requested. ThiS document
when signed by the City Planner constitutes a temporary Certificate Llf ZLlnmg compliance and allows construction lLJ commence Before LlcCupancy, a Ccrtltkate Llf Occupancy must be
isslled
Planning Director
Special Conditions, if any
Date
24 hOllr notice for all inspections (952) 447-9850. fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372