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Date Rec' d
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
r;;;::s;-'" ... .. ...-:
I. 14185 (hrfl_c.Jf'
LEGAL DESCRIPTION (office use only)
LOT BLOCK l6ADDITION
~ Et Ir:,iant I PERMIT NO. 00 -- -53 V
C"Ll r {-
1. '\ c
t-'C
[ ZONING ,--) I
gL( -or;t;
OWNER
(Name)~(L .~_fLOCS,o^-1
(Phone) Q t:, I ~ - 3 I ~ ~. ( 0 7
(Address) S'/4n1 e
4rUOiJ --'L.-
qs
BlITLDER '
(Company Name) l-6 ~l.V0<".><::l-=- ~~o.&-eQ~f'\~
(Contact Name) Sh:lw., 12..t.s €
(Address) kc-euX2
(Phone) 95;j~~i{-SS~~
(Phone) (;;,/ 3A8 - 8Sl..
JJ\ ~ 55 '-t ~6
TYPE OF WORK 0 New Construction ODeck o Porch ~Re-ROofing ORe-Siding OLower Level Fimsh 0 Fireplace
OAddition DAlteration OUtility Connection 0 Misc.
CODE: OJ.R.C. OLB.C.
Type of Construction:
Occupancy Group: A B
Division:
II
F
I
ill IV V A
H J M R
2 3 4 5
B
S U
PROJECT COST IV ALUE $
(excluding land)
J
E
oe
6;). 7D .'--
I ht'feby certify that J have furnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authonzed agent for the
above.mennone property and that aU constnlction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildIng
official ca eves permil for ju~US Further:nore, I hereby agree that the city official or a de~ignee may enter upon the property to perform needed mspections.
~ d:; al?4-4-3D<o ~ '6- /3-0'-
Si ture Contractor's License No. Date
x
Permit Valuation rl,'5(7) ---
Permit Fee $ -It! ' 7~
Plan Check Fee $ (J d-~
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Pennit When Approved
Dale
Buildinl! Ollicial
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ ----
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 requl'Sled. This document
when signed by lhe City Planner consmutes a temporary Certificate of Zoning compliance and aliow. construction tJ commence. Before occupancy, a Cl'ftifkate of Occupancy must be
issued
Planning Director
Date Special Conditions. if any
24 hour nolice for .11 inspections (9!12) 447-98!\O. fax (9!12) 447-424!1
16200 Eagle Creek Avenue Prior Lake. MN 55372