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oi villa+ CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
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TEMPORARY
I)UTILITYCERTIFICATE CONNECTIONOFZONINPGEICINIOMITPLIANCE
, PERMIT NO. /2.
, ya.... Avo... - _
.tease or *nt.and sign at botiont)
ADDRESS ZOIWNG office ow)
f
°oil. 1:1011.41, 7 , ,..,.. 4,,>(1 I'Arew71: 1
.. ._...
......,... _____ .. „......_... ,..___
LEGAL F/ESCRII'TION(office rase only)
LOT BLOCK ADDITION Q OA A/A//i 2 AL° PID 2.5-,00-7, 0 1 7,.0
owNiii, i , ,,,._,_ ,,,,-
I--
,9 . $.9
(Name) ', ' iiPiicic (Phone) .na-- 9- .9
,03
1 //1.,,b 7 -a._ _ ..,
BUILDER , 1
' A' 4 .s,,/ P - -
(Company Narne),V/17effet: Crerite9t9/57 1'4 „w 4,: .././.,----s---0, (I'llorte) - e(5
411.4f' (Phone) '-----** --: - e -_____6_5,,L7ge
(Contact Name) . 4— i ..e.•E•e A . Aiwa -Nisa.iie—„....r......
New Comiage i
ypE OP WORK
(Address)c)199/ 4/A Sr,„t* 3-;le IC,/ ./4/ 55/07
CODE;
ni...c. ci...e*.e. _ ,
T13 ni,ck)o EIDet.i; 010 ith ORe•Rooling C3Re
0Additiott jataAlteration 011tility Conetection
Stding DI-owe;Level Finial, 0 Pireplace
0 httse. C.-67„47, ____±,V.ildi_.1)0 YJ
Type of Construdiont I II
A B E 1: III IV V A B i ..e i-I
PROJECT COST/VALUE $ ,if,d_t.a i 1
(exclitding land)
Oeotpaney Group; 11 1 Ivt R S ti
Divisiont 1 2 3 4 5
I hrtehY certify th t Ior thronhed iter rna:'• on this application which it to the teat e4 my kitOadedire nee Sad Offera 1 altvet tify that I atn the wate re authottred agent for ht
/abovelnennott ,. and I • it C s. ,ram wilt conform to iii exiatold USES sod local laws id snip proceed in accordance with altbinitted tdalaS I am aware that the budding
ontrtal ran t.,17 w., t 0 tar ,S41:0400;00e, .I rd Mb).agitv that thorny official ot a dertgOre May Staff upon the piopeoy to perform needed ttopecitons
Aitee
, .41 i i i ,.,:, . ,„...._ _ .., -Totif./1"*R.
/
. p. or:,- tore Contrattor's LIcende No, 17ate
Piitnit Valuation Park Support Fee it $ - -
Permit Pee S SAC N S
Plan Check Fee $ Water Memr Size 5/8";I"; S
..... —
State Surcharge S Pressure Reducer S
Penalty S Sewer/Water Connection Fee # S
Plumbing Permit Pee $ Water Towel Fee It S
Mechanical Permit Fee $ Builder's Deposit $
Scorer&Water Permit Fee S Other $
Gas Fireplace Permit Fee S TOTAL DUE1 3/1„32- $
.. clit,t,6)1 1
This Aproltratiort Becomes Your Building Pentair When Approved Paid - -741 -AV R t1-,j.tt No. • _1111°
Date 3 2_ k....
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1
.
111111,attig UAW-tat Date j
Tim is to tertily that the trotat in the above applieatton arid accoinpanying doconnents ti to accordance With the City 2,aning Of&native and may rOCSed da requtated This dtIttnent
when sinned by the Coy Names commutes a ternowaty Cetralcatc or zoning cornpliancv and attaws mat tinction to comentnce Before occupancy a Cerittirass,vtf Occupancy must be
Istsett
. _
Planning Dircetor Date Special Conditions,.if arty
24 hour notice fur all Ina/wenn-us 0521 4474E4l,las(952)447•4245
4646 17akota Street Prior Lake,MN 55372