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Date Rec' d
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and silm at bottom)
ADDRESS
5Z7CP
1. White File
2, Pink City
3, Yenow Applicant
tf-/3'-O!
PERMIT NO.
e,eL)O~ (!,leu,{5
LEGAL DESCRIPTION (office use only)
LOT I BLOCK.3 ADDITION ~(J~/(A/& #//.A..,.G Z;(/O
OWNER
(Name)
(Address)
(Phone)
~~~~R )1'6-1~c.. t.xtu\or 5t, 1ut'llJ^.$
(Contact Name) b1 (maJ.,..../ 'T'- W r" ictAStYl
(Address) ),,10 { (O~ JtvfLiJ E- t {)l(I'''\l. .11.A1
TYPE OF WORK
o Misc.
CLOSE FILE
10/28/03 MP
,€../
PID 75-0Ih-OZZ-O
(Phone) 7 ~~ -1 'l:J,-Ce1 0 t/
(Phone)-!RIJ--80Y.f- ~1 q
~'l1
OPorch
-
~Re-ROOfing
OAlteration
ORe-Siding
OUtility Connection
I hereby certifY that I have fumism:u llUVl1uauvu Uu ____ -n __ _ est 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 theJwilding official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
~t~~;7,ed~sP::s~ ;LO~JO~j q,.. rrd/
~ Signature Contractor's License No. Date \
I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
I Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
2/500.00
$ 7l./.7S
$
$ I.~~
$
$
$
$
$
Th;'~~_P=itWh<nA"",""d
BufIding Official Date
OAddition
.UE (excluding land) $
I Park Support Fee
I SAC
I Water Meter Size 5/8"; I";
I Pressure Reducer
I Sewer/Water Connection Fee
I Water Tower Fee
I Builder's Deposit
lather
I TOTAL DUE
Paid
Date
"7'~ . t/7J
9"1-?~O/
#
#
#
#
'$
$
$
$
$
$
$
$
$ '70.0 0
Recei~. #057/
By/~
r
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