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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORA CERTIFICATE OF ZONING COMPLIANCE
\oS<l. -&-t ~ lo AND TILITY CONNECTION PERMIT
~~/aJctO PI;
Date Rec' d
(Please n at bottol11)
ADDRESS~--
15 'f 7~ B,,{i:~ ~ y
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File
City
Applicant
PERMIT NO.l-10S"L-
Au (.AJt
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ZONING (offiee use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name) L fA)
B~O(}.J A.J
(Phone) Lj~"7 -., Y 8 / ~
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address) 0/3 ~
5(M/Yt~/tU6 Lo.AJ sr:
rfi 50,.v S 1M,+( (/f!/ /V6
50 vT If $ U"tt-z?A.) < /'jk'!
6LV~.
(Phone) 9S:;l - 01 '9 2- Sg [:{-6
(Phone)
.J'O,,,Qjj.AA...J, /)1/(/ s-5 35 ~
TYPE OF WORK 0 New Construction ODeck OPorch ~Re-Roofing
OAdditlOn OAlteration o Utility ConnectIOn
ORe-Siding OLower Level Finish
I
E
II
F
I
III IV V A
HIM R
2 3 4 5
B
S U
PROJECT COST /V ALUE $
(excluding land)
o Flrepl.!ce I
s>go ~
I
I
CODE: DI.R.c. DI.B.c.
Type of Construction:
Occupancy Group: A B
Division:
o Mise
I hereby certify that I have hlrmshed information on this application which IS to the best of my knowledge true and Cllrreet. I also certIfy that I am the owner or authol!zed agl'l1t I'Jr the
,lbilvc-mentlllned property and that all constroctllln wlll contlrrm to all eXIsting state and local laws and Will proceed in accordance with submItted plans I am aware that the blllldlng
otlicial can H'V( - - permlt r Just Furthermore, I hereby agree that the CIty official or a deSIgnee may enter upon the propc11y to pcrform needed lIlspect10ns
2D099973 /qh1tf7 -
Contractor's License No. ate
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8", ]", $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
~echanical Permit Fee $ Builder's Deposit I $
Sewer & Water Permit Fee I $ Other $
$ TOTAL DUE $ ~-
Paid ReceIpt No.
Date By
TIns is to certify that the request U1 the above appliCJtIOn and accompanYlllg documents is U1 accordance with the City Zoning Ordinance and may proceed as requested ThIS document
when signed by the City Planner constItutes it tempurary Certificate uf Zomng compliance and allows construction to commence Befure occupancy, a Certificate of Occupancy must he
issued
Planning Director
Date
24 hour noticc for all inspections (952) 447-9850. fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
Special Conditions, if any