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ADDRESS
Date Rec' d
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White File
2. Pink City
3. Yellow Applicant
PERMIT NO.&;2-t/37S-
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LEGAL DESCRl.t' lION (office use only)
L~Ifu:OCK ADDillON :Ll!jjJ//;/-it>A-O- &u~
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(Address) /b 4fLt ~IY ~"AJ."
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(Contact Name) Q.\.A- ~J\
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OWNER
(Name)
(Address)
;;2/L/
TYPE OF WO
1St- Sf ~~
o Misc.
CLOSE FILE
10/28/03 MP
rJ.A'V'
ZONING (office use)
RI sf)
PID d,l.j- o Clb"tflfC,-' 0
(Phone) !l~2- LJ41, If., J.2 C;
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(Phone) -1{,1- LI q 2-.2U-:7
(Phone)
JO I d/J-IV'
ck
OPorch
OAddition
~Re-ROOfing
OAlteration
ORe-Siding
OUtility Connection
I hereby certifY that I have =11~" ..&--._.. ich 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
submitte I s. I am aw that the building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
;ter up th property to p bP neede~!lPe~ ~ / 35'1 <gb '-1_ /1-0 J
Signature Contractor's License No. Date --
I per!t Valuation
I Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
cl).soO.--
$ 7t/-7S
$
$ /;,;IS-
$
$
$
$
$
This Application Becomes Your Building Permit When Approved
Building Official
Date
replace
~ COST IV ALUE (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
I paiJ 7(,. ~E}
I Date l/ - {~ -0 "I----
#
#
#
#
$
$
$
$
$
$
$
$
~
$ '7t?OU
. .
Receipt No. 'If/70 ~
(1/~
By
. 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