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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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Date Rec j.I
2 _ -z.-f. of
I. While
2. Pink
) Yellow
I PERMIT NO. tJ8. 0054
File
City
Appliclnl
ZONING (office use)
f ( \ 0 ~ L II r:. e
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
&=RN;~lV\ ~_be(\l1 Srv (it
(Address) 4(P~\i LC\V\dcIIA l~''\ i flilCV L?l~l'
BUILDER GuVl tv' vi { nv _
(Company Name) <~ f v I V\ ?)<" ( t-X-\-( (I U-, ,LL C
(Contact Name) J::;O n (,\ \/ U (\~ X?I L1
(Address) f 0 f)j))( ll,;: 2, f ( : V / I vl ~ (,
,
(Phone) qSl .41-1' &,u1:S
(Phone) 0) l ' -11 (), I C7C; 1
(Phone)
TYPE OF WORK 0 New Construction ODeck o Porch I&'JRe-Roofing 1?;JRe-Siding OLower Level Finish 0 Fireplace
OAddition o Alteration DUtility Connection 0 Misc.
. CODE: DI.R.C. DI.:B.c. PROJECT COST /V ALUE S S11?;()O,V,0
Type of Construction: I II ill IV V A B (excluding land)
Occupancy Group: A B E F H I M R S U
Division: 1 2 3 4 5
I ht'feby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above-menuoned property and that aU construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware Ihat the building
official can revoke this permit for i:Jst c.ause. Furthermore. I hereby agree that the city official or a designee may enter upon the property to perform nee!d/lnspections.
X ~1/\>s1I}~\,\t;~;<t:t1l4 2..o+D11 S4- 13/o'i
Sign ture Contractor's LIcense No. Date
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Pennit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Pennit When Approved
Buildinl!. Ollicial
Date
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE S
ThIS is to certify thatthc request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as rcqu('sted. This documenl
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 IDircctor
Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 4474245
16200 Eagle Creek Avenue Prior Lake, MN 55372