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of PRI0+ CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
U
i
AND UTILITY CONNECTION PERMIT
M
I. White File
. pink City PERMIT NO. / O 5
3
3. Yellow Applicant �
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
y3 a3 DaV0+a S +. 553 a
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWN)R C\ d d- Sherri 12�GTZ. ( Phone)ct5g 1 -114-7 6
(Address) _I 3 Q 3 Da1L O 4-a. S-h, - Pr i or Leda ,M N 555 37 a 1
BUILDE 1 co c Q
(Name) I o 1,3 C riC f +5 (Phone) CP5 / `d 0 /be
(Contact Name) a I ) 0.11 C1/41 SC) , l (Phone) I
(Address) '"1-1 Q L 0 N_ OalL )& i S IN `1 r�ct Yl // I/ 65/ z I
TYPE OF WORK ❑ New Construction DDeck ID Porch XRe- Roofing ❑Re- Siding
['Lower Level Finish ❑ Fireplace DAddition ❑Alteration ❑ Utility Connection
tg Misc. WI n a J W S PROJECT COST /VALUE (excluding land) $ t 2) t- -I a G
I hereby 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 - mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with
submitted 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 u • • the property to pe rm ded inspections.
X /,,.. ao IG3LIq3 10 - /O
le Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ Pressure Reducer $
Penalty $ City SAC and WAC # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ 79. 75
This Application Becomes Your Building Permit When Approved Paid 7 y. 7r R ipt No. (Q /(p 08
Date /0.4./0
Building Official Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
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 Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
16200 Eagle Creek Avenue Prior Lake, MN 55372