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CITY OF PRIOR LAKE BUILDING PERMIT,
"\~oB TP1PORARY CERTIFICATE OF ZONING COMPLIANCE
., I ~~ \,0 AND UTILITY CONNECTION PERMIT
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Applicant
PERMIT NO.07 - O/?(P
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION ~Ah1~c. //.16
OWNER ~7n. BuA
(Name)
(Address)
PID
(Phone)
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(Address)
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(Phone) q)l, "'fer ~S-O<J
(Phone) UI '[/' j~9-13 Z-L
TYPE OF WORK D New Construction DDeck DPorch ~e-Roofing ~Re-Siding DLower Level FinIsh D Fireplace
DAdchtion DAlteration DUtility ConnectlOn
CODE: ~I.R.C. OI.B.C. D Mise.
Type of onstmction: I II III IV V A B
Occupancy Group: A B E F H I M R S U
Division: I 2 3 4 5
PROJECT COST IV ALUE $
(excluding land)
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t I have hlrmshed 1Ofmmatlon on thiS applicatIOn which IS to the hest of my knowledge true and COlTect. I also certify that I am the owncr m authollzed agent 1m the
ahove-mentlLl roper and that all constructlLln will confmm to all exlSt10g state and local laws and will proceed 10 accordance with suhmltted plans I am aware that the btllld10g
vOK'tlus <.' It forjllst cause Furthermore, I hereby agree that the City official or a deSignee may enter upon the prOpet1y to pert()[m needed mspcctu)J1S
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Signature
Permit Valuation 2'5,00. () 0
Permit Fee $ 7l.(,7C;
Plan Check Fee $ -
State Surcharge $ ; I Z S-
I Penalty $ .
i Plumbing Permit Fee $
~echanical Permit Fee $
Sewer & Water Permit Fee I $
:
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
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Date
Contractor's License No. ~ L-leJCI
L Date l..(- J-07
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
,
Water Tower Fee # $
Builder's Deposit I $
Other $
TOTAL DUE $ 76rOO
Paid
Date
I ~~ceiPt6r~3255
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ThIS IS tn ('Citify that the request in the abuvL' applicatiOn and accompanYlIlg documents is 111 accordance WIth the City Zoning Ordinance and may proceed as requested TillS document
when Signed hy the City Planner CllnSC1lutes a templlralY Certiticate of Zonll1g compliance and alIllws construction tn commence Before occupancy, a Certlticate of Occupancy must be
JSSlIL'd
Planning Director
Special Conditions. if any
Date
2~ hour notice for all inspections (952) ~47-9850, fax (952) 4~7-~2~5
4646 Dakota Street Prior Lake, MN 55372