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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
P(.A<?ffK.
.S'ov!7t Meut,
(Please type or print and sign at bottom)
ADDRESS . t)(po3 O[k~
J..- D~'
Date Rec' d
~. 29 O(p
I While
Pink
Yellow
I PERMIT NO. tJ f/r ~ 6fj
File
City
Applicant
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT 3 BLOCK ADDITION
OWNER
(Name)
(Address)
BUILDER 0
(Company Name) T. I . c.. L~~Pe
(Contact Name) O~ ~\Y..\e'l
(Address) 14>>1.(
'1
cf(~
PID
'//}-003
(Phone)
(Phone)
(Phone)
7S;}..- ff5~~ 76CO
::;> :. .'~ t:;-'
,.. LX \s'"' j '-.
I I
u..N\.~\l"'l(
Y>l.f\.
~~ 3 06
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing
OAdditJon OAlteratwn o Utility Connection
CODE: OI.R.C. OI.B.C.
Type of Constmction:
Occupancy Group: A B
Division:
I
E
II
F
I
III
H
2
IV V
I M
3 4
r:;IMISC'
ORe-Siding OLower Level FinIsh 0 Fireplace
I 'E~ST t~
. ~rJwlli /~0I'tT701J S,,\S,Iiit-M
\
A
R
5
B
S
PROJECT COST IV ALUE $
(excluding land)
U
I hereby certity Ihat I have furnIShed mformation on this application which IS to the best of my knowledge true and correct. I also certlfY that I am the owner ur authorIzed agent for the
ab<lve-mcntlOned property and tlut all constructIOn Will conform to all eXlstrng state and local laws and will proceed in accurdance with submitted plans I am aware that the buildmg
ntlicial can revoke this permit for Just cause Furthermore, I hereby agree that the Clty official or a designee may enter upon the property to perform needed inspections
x
D>'(} Pi"~y
Signarure
Contractor's License No.
Permit Valuation
Permit Fee $ J./ tJ, ---
Plan Check Fee $
State Surcharge $
I Penalty $
! Plumbing Permit Fee $ 1-0. () 0
~echanical Permit Fee $
I Sewer & Water Permit Fee I $
I Gas Fireplace Permit Fee $ i
This Application Becomes Your Building Permit When Approved
"uildlllg Omcial
Dale
b-OI-'7 -06
Date
\-
Park Support Fee # $
SAC # $
Water Meter Size 5/8", I"; Z 'f $ ~SO. 0 0
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # I $
Builder's Deposit $
Other $
TOTAL DUE $ 1130, -
K;:;~ '7~~:;;'
I ~~"J:- Sj'7 (, 7
IThls IS to celtlfY that the .equest m the above apphcatlon and accompanyrng documents IS m accOIdance wllh the Clly Zonmg Oldmance and may ploceed as lequested TIllS document
I when Sll 'd by the CIty Plannel constItutes J tcmpOl,u)' CCltlficate of Zomng complIance and allows umstlllctlOn to commence Befort' occupancy, il Celtlficate of Occupancy must be
I "sue 6
I p]anmngDlre~t~ 1~~atf
24 hour notice for all inspections (952) 447-9850, fax (952) 447-.U45
16200 Eagle Creek Avenue Prior Lake, MN 55372
/
Special Conditions, If any