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o !R 'o p CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
f: . / . . : . e TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
. ' ' AND UTILITY CONNECTION PERMIT
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I. White File
2. Pink City PERMIT NO. ll_ Ha Z
(Please type or print and sign at bottom) Yellow Applicant
ADDRESS 5 i Li ✓ J ZONING (office use)
LEGAL DESCRIPTION (office use only) _ .
LOT BLOCK ADDITION
PID
�
(Name) )O
'4— E v rerht— (Phone) �..
� � � " y5 �5� f
(Address) v I
BUILDER
(C ompany Name) c \A((2- �
(Phone) __9_52_____9 �{�(1-61
(Contact Name) tl ;n
M ,, (Phone)
(Address) a j PA( lk'Y� , Sf, PO Or J� 1 t' ► N 7 Z
TYPE OF WORK ❑ New Construction DDeck ❑Porch 62‘ ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
D atYO
Addition ❑Utility Connection ❑ Misc.
• CODE: QLR.C. QLB.C. PROJECT COST /VALUE $ 13._ ,00
Type of Construction: I II III IV V A B (excluding Iand) i
Occupancy Group: A BE F HI M R S U
Division: 1 2 3 4 5
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 an the owner or authorized agent for the
above - mentioned propel. . -.-- hat all constructio, conform to all existing state and local laws and will proceed in accordance with submitted plans. 1 am aware that the building
official can rcvo f�.. it for just cause. ore, I here cc that the ci ty official or a designee may enter u on the property
_ P to perform needed inspections.
X �.�i 2D-102_6i4
�' Contractor's License No. Date
Periirit V. uation Park Support Fee #
$
Permit Fee $ SAC
Plan Check Fee $ Water Meter Size 5/8 "; I";
$
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
G
$
as Fireplace Permit Fee $ TOTAL DUE
. $ ? 9 7.5"
This Application Becomes Your Building Permit When Approved Paid
AVAIrMalimm Recei • t o. , ,tar m
Date AW '
B ,i
Building Official Date
This is w certify that the request in the above application and accompanying documents is in accordance with the Ciry 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
24 hour notice for all inspections (952) 447 -9850. fax (952) 447 -4245 Special Conditions, if any
16200 Eagle Creek Avenue Prior Lake, MN 55372