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o� Piti CITY OF PRIOR LAKE BUILDING PERMIT, $z
'.(71.57) TEMPORARY CERTIFICATE OF ZONING COMPLIANC :i U LS u
"' m AND UTILITY CONNECTION PERMIT JUL 1 3 2009
'
1 White File —
2. pink city PERMIT' • _ - -_ _. :.
3. Yellow Applicant f
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
\ C O I %M 61i nd c04.e. - \ -- r 1
LEGAL DESCRIPTION (office use only) ,
LOT BLOCK ADDITION PID
OWNER
(Name) Y) \ C.r a P.UI o sand ler (Phone) eSa-) aa( L200
(Address) 11p:3m c6\ 2 \ S E
BUILDER (�, �,�`
(Company Name) la €1 lQX k \ �([ 1�' (' tin l 1 h C (Phone) -- I to 5930 3
(Contact Name) , ,,EY (Phone) 1 (pq ? (_\ 00
(Address) ? J 1 `Q t.y) 0 , 9\x, 6c��I, VA 1-ki-
TYPE OF WORK ❑ New Construction ['Deck ['Porch / 12e-Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
['Addition ['Alteration ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc:
Type of Construction: I II III IV V A B '' I
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ 11 "1 (i o 1 3
Division: 1 2 3 4 5 (excluding land)
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 upon the property to perform needed
inspectio .
X 1- L. A i ■6(A VI 61 — 1 110 101
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 $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ 76 ...1.
This Application Becomes Your Building Permit When Paid 'AP -----' I eipt No. 58 4-0
Approved rls+a 7 a l R . .