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ADDRESS
~I / s?J
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
~. ~i~~e ~::y PERMIT NO./)/_ /'310
J. Yellow Applicant ( /1' -/
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ZONING (office use)
RISD
LOT IIJ BLOCK
LEGAL DESCR!ynON (office use only)
ADDITION
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OWNER
(Name)
(Address)
(Phone)
BUILDER <.. _ I . - . tL -;) f'
(Name' JCV\M..bU1 f'..-.OOT"~
(Contact Name) Cor'l Sc1I'k~ d:JL
.
(Address) 140 w ~tf>~)+ -#-10 ~
TYPE OF WOF
(Phone) qt;;1..-8fJfJ-<.(CfJ'if}
(Phone) r;f2..-~n - 3 Sl>b
,
DPorch
DAddition
'R,Re-ROOfing
OAlteration
Dutility Connection
ORe-Siding
CLOSE FILE
o Misc. 10/28/03 MP
~lace
:::OST IV ALUE (excluding land) S
I hereby certify that I have furnished mtormauon un uUJ ayy~~____ .. ..._h 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 pi . I a a 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 e prope erform needed inspections,
D 62-0 1',7 65"'<t
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x
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
Contractor's License No.
$
$
$
$
$
$
$
$
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# $
# $
$
$
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$
$
$ 1(Pj;P-
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By rj-
Park Support Fee
SAC
I;d~
Water Meter Size 5/8"; 1";
Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
This Application Becomes Your Building Permit When Approved
I Paid
I Date
m t, , (!f:'
. i I - ;;..0 -0 I
Building Official
Date
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
16200 Eagle Creek Avenue Prior Lake, MN 55372