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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE. :::' A
AND UTILITY CONNECTION PERMIT '!3f z.- z.....~ 7
ltl Im\ \ Se..
Hc)ri
~:~. ~::y I PERMIT NO. lJ J - 0 3 -,0 I
3 Vell... Applic:o.. . (4 .
I ZONING ,"""-) I
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID z.c::-. zAt.f. 0 I q. U
OWNER' -+- ~C\ V\
(Name) fY\,Ke_ ~lU
(Address)
lD e'l ()(.\ cYi
(Phone) CK~.2qT'Y6L{5
=~N....)t.h> IIv"an/ ~h(flr"-{n.ba
(Contact Name) dJ (~
(Address)5&'I/ /J,'~m()r/a/ . /Y. 7~ 'tuttA,.
(phone) 1/61 '~:J; 9. ~ 3 x)
(phone)
,#' 6-5tJ E OL
o Fireplace
TYPE OF WORK O\New Construction DDedc OPorch ORe.Roofing ~.Siding
OAddition ~teration DUtility Connection 0 Misc.
,CODE: Mi.R.C. OI.B.C.
Type of &"nstnu:tion: I n ill IV V A B
Occupancy Group: A B E F HIM R S U
Division: 1 2 3 4 5
DLower Level Finish
$ B;Y60 .C0
PROJECT COST /V ALUE
(excluding land)
I brreby cenify that I have furnished information on this application which is to the best of my Imowledae b'Ue and correct. J also certify that I am the OwnlT ur authorized agent for the
above-menhoned property and that aU consb'Uction will conform to aU existina state and local laws and will proceed in acwrdance with submilled plans. J am aware that the buildinS
official can =0 this permit for just cause, Furthermore. J ereby a he city official or a desisnee may enter upon the property to perform needed Inspections.
X rt <+tJ~ g/)--~ For/' 51d l/Cr=t_-
Contractor's Li* No. Date
Permit Valuation
Permit Fee S
Plan Check Fee S -
State Surcharge S
Penalty S
Plumbing Permit Fee S
Mechanical Permit Fee S
Sewer & Water Permit Fee S
Gas Fireplace Permit Fee S
This Application Becomes Your Buildinl Permit When ApproYCd
~~
Buildin Omcial
~ ft.:z..A, 7
Date {
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer S
Sewer/Water Connection Fee # S
Water Tower Fee # S
Builder's Deposit S
Other $
TOTAL DUE $ 7 G. ao
I Paid"~'~O
Date ~ ~~7
I Receipt No. 53 '?/7
,By ~
~~ (p~'3
nlls is to certify that the request in the above application and accompanying documents is in accordance with the City ZoninS Ordinance and may proceed as qucsted. This ducumem
when sisned by the: City Planner constitutcs a temporuy Certificate of Zoning compliance and allows consb'UClion to commence, Before llCCUpancy, a ClTtiflClte of Occupancy must be
issued
Plannins Dim:tor
Date Special CODditions, if an
24 hour notice for all Inspections (~:Z) 447-98!iO. fax (~:Z) 447-4:M5
16200 Eagle Creek Avenue Prior Lake. MN 55372
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