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(Please type or vrint and sign at bottom)
ADDRESS
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White File
2. Pink City
3. Yellow Applicant
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LEGAL DESCRIPTION (office use only) V
LOT BLOCK ADDITION 11P d 30
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OWNER
(Name) lC\ Y'Y"'l A ~ '\ \- 'r\
(Address) lLl JS'tJ r1\~~ \\~\('. ~ 6
BUILDEl\ .
(Name) II n 11-€'~ CDY\St rv-.-c.:h'c\"(\
(Contact Name) .-n{+~,^'O l'x(,,~::~pS,
(Address) JJ(j~ L", r 1 1")<' ,'"p \NeS+
TYPE OF we
o Misc.
CLOSE FILE
10/28/03 MP
I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
Plumbing Permit Fee
Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
(Phone)
(Phone)
(Phone)
'eck
o Porch
~Re-Roofing
lireplace
OAddition
OAlteration
T COST IV ALUE (excluding land) S I ~ , d t.oq . ~ y
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$ jLf.. 7t.J
$
$ /'OJ
$
$
$
$
$
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
I Other
I TOTAL DUE
J ~'C
I Paid?77~_cj
I Date 10-;)0-01
This Application Becomes Your Building Permit When Approved
Building Official
Date
Date Rec' d
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PID,.JS-' q'Jo- ()7 g-o
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ORe-Siding
OUtility Connection
# $
# $
$
$
# $
# $
$
$
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$ 7".OJ
Receipt-No. Lltl';~<i
By ~F/
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