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Date Rec'd
CITY OF PRIOR LAKE BUILDING PERMIT,
TE~ORARYCERTnnCATEOFZOmNGCOMWLMNCE
AND UTILITY CONNECTION PERMIT
ADDRESS L/ 1% 7 g 1'~IAC C'- Li V' $', t .
LEGAL DESCRIPTION (office use only)
LOT BLOCK:A ADDmON
OWNER
(Name)
Pe-k ~ trJl".,~
V- 8 8 7 gCtVl<c....
C,'y
(Address)
~=:Name) ~~9t( 5,,}(,....) I~ (.
(Contact Name) k, c...'k- ~~ I
(Address) /'301 6 C/.# ,RJ. :#//7
~.::e ~~ I PERMIT NO. /)/ -- 'J /f II
) Yellow Appliainl uCo ~
Pv-.'or'" Lc.\.J(e A,~ tJ
f
I ZONING ,--> I
SA ()'1f/
~ -- Oq/-
PID
(Phone)
?S-Z - ~<-6 -?. 'I 'if 7
S;E.
(phone) 9SZ - 7ft - 30 }i b
(Phone) G:,12- - ~ /8 - c: s> 7 'I
~Vlr.-t511! I(f /A /lJ S-S.5"3 7
-Siding OLower Level Fimsh 0 Fireplace
TYPE OF WORK 0 New Construction DDec:k Dporch ORe.Roofing
OAddition OAlteration OUtility Connection 0 Mise,
I hereby certiIY WI I ha~ furnished information on Ibis application which is 10 the bcsl of my knowledse ttur and corm:t, I also emity thaI I am 1M owner UI' authorized alCnt fur 1M
above-mrnboned property and thaI all COIlSuuclion will COlIform to all existing Slale and local laws and will proc:eed in ac:corcIana: with submilled plans, I am aWaIe wt the buildinl
official can - permil for just usr Furthmnorr. I hrreby qrrr thaI the city ofllcial or a drsignee may enlel' upon the property to perform needed mspcctions,
zo'f 508'" 7 '1// Y /06
Contractor's License No.
CODE: OI.R.C. OI.B.C.
Type of Constnu:tion: I
Occu.pmcy Group: A B E
Diyision:
x
Permit Valuation
Permit Fee S
~~Ch~Fee S
State Surcharge $
Penalty S
~umbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee S
n mlVVAB
F HI MRSU
I 2 3 4 5
This Application Becomes Your BuildinI Pmnit WheIl Approve.
Buildin2 Official
Date
3,900
,
PROJECT COST IV ALUE S
(excluding Ian')
Date
Park Support Fee #- S I
SAC #- S
Water Meter Size 5/8"; 1 "; S
Pressure Reducer S
SewerlWater Connection Fee #- $
Water Tower Fee #- $
Builder's Deposit S
Other S
TOTAL DUE $ r(~(
I P 'd
D~te
I ~~ro~ ,6-U~ I
~0i~-b
This IS to certify thalW requCSI in the above application and accompanying cIocumrn15 is in accordance with the City Zoning Ordinance and may proceed as reqlll.'Stl'd, This documenl
wlIm sitlned by the City Planner constitutes a temporary Certificale of Zenina compliance and aUows construction 10 commence - lIefllR occupancy. a Cl'rtiflCale of Occupancy must be
issued
I'IaJmin& DireclDr
Dale Soecia1 CoaditionI. if aDY
24 hour notice for 811 inspections (~2) 447-98!iO. fax (m) 4474245
16200 Eagle Creek Avenue Prior Lake, MN 55372