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ADDRESS
3"3 Co G::, rr< MOv\.\-
CITY OF PRIOR LAKE BUILDING PERMIT,
Q(Os.e.. T:tj:MPORARY CERTIFICATE OF ZONING COMPLIANCE
fl- ~ J;.{ AND UTILITY CONNECTION PERMIT /0 / l-~ I
~~&~~ I~ /07
I ~;~:~e ~:~y PERMIT NO. 07-- /0 "'~J I
Yellow Applicant ~ ..,
Date Rec' d
Mfocf!J~
.s+- J.J vJ
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
p~ \0\- ) e. (
33lPCo
r-n ;. \ ^-
. ~
n.~lMO\A ~ ~JrCJJW
(Phone) q ~ 2 ~ Y't'o.. c; t:t (, ,
(Address)
i BUILDER
(Company Name)
(Contact Name)
.--
~ 12 c ~ .",^-~\r"",f. :+-J~",,-
^-e~ 5~1 "'-
7 (p ~ "Z ~L(!'V'\:t...~ ~r
(Phone) pt5 2 ,..q 4/- ? au I
(Phone) ft?1Z, - ~'S'- 7<t2 ~
(Address)
TYPE OF WORK 0 New Construction ODeck OPorch ~e-Roofing ORe-Siding OLower Level finIsh 0 fireplace
OAdditlOn OAlteration OUtility ConneCtlon
CODE: ~LR.C. OLB.C. o Mise.
Type of onstmction: I II III IV V A B PROJECT COST IV ALUE $ 7 dOtJ'- c.e)
Occupancy Group: A B E F H I M R S U (excluding land)
Division: to 2 3 4 5
I hereby certify that I have furmshed Informalllm on this application which IS to the best of my knowledge true and mITecl I also cert.fy that I am the owner m authorized agent tor the
above-mentlllned property and that all mnstnlCllon Will conform to all ex.sung state and local laws and will proceed In accmdance with submltled 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 upon the prope11y to perform needed inspectIOns
X 77 ~ "'2d"!> Z z..Y3 3. 10 -ZS-07
I v Signature Contractor's License No. Date
Permit Valuation tt2 S' 00, f)'t)
Permit Fee 1
$ 74. 7>
Plan Check Fee $
State Surcharge $ I , 2..-~
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace PermIt Fee $
Park Support Fee
SAC
# $
# $
$
$
# $
# $
$
$
$ 7".()fJ
Receipt No. ~"'f'(' ~
By ~-r-,
Water Meter Size 5/8"; I";
Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
~~
llllildllH! Ufliclal
--Li~t: 107
I Paid ~ 7~,DD
I Date '''/'2-~(07
This Application Becomes Your Building Permit When Approved
ThIS IS to certify that the request in the above applicatIon and accompanYIng documents is 1I1 accordance with the City Zoning Ordinance and may proceed as requested ThiS document
when signed by the City Planner constitutes a tempora.y Cert.ficate of Zlmrng complrance and allows constrUcl1on to commence Before occupaocy, a Certificate of Occupancy mllst be
isslIed
Planning Director
Date
24 hOllr notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
Special Conditions, if any