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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
I. White File
2 Pink City
3. Yellow Applicant
\ PERMIT NO. O(P .- 55 ~
I
ZONING (office use)
"ro~
ADDRESS
z.~ 1- BJI $am rtreflt
LOT
ADDITION
s W I Prior 1..dk~
~i~
BLOCK
PID E?S-/7ol-00h-b
LEGAL DESCRIPTION (office use only)
<..0
(Phone) '/.51-" t/t/7.. 8670
5537;)-
tnAl
BUILDERS I /l .
(Name) ~n(jalL \...4rt~non
(Contact Name) Kevlh S'C1naau..
~
(Address)
(Phone)
(Phone)
95?-- 41J3" 9/00
{, 11- 3t3- 0/2.0
~<;.c.11
TYPE OF WORK
o New Construction
DDeck
o Porch
ORe-Roofing
gRe-Sidil)g tL
sofHt ., fa s "1"'-
OUtility Connection
OLower Level Finish
o Fireplace
DAddition
o Alteration
o Misc.
PROJECT COST IV UE (excluding land) $
/36/6.
I hereby certif'y that I have furnished information on this application which is to the best of my knowledge true and correct. I also certif'y that I am the owner or
authorized agent for the above-mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with
submitted plans. I am aware that the building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
enter on the prope to perform needed. spections.
'-15-06
Date
Contractor's License No.
This Application Becomes Your Building Permit When Approved
I Paid
Date
~t;
~;:)(}~
# $
# $
$
$
# $
# $
$
$
$ (p .
I ~~cei~t ~ /,,?3Zl
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
Park Support Fee
SAC
Water Meter Size 5/8"; I";
Pressure Reducer
City SAC and WAC
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
Building Official
Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director
Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372