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CITY OF PRIOR LAKE BUILDING PERMIT,
r \\ ~F,&frORARY CERTIFICATE OF ZONING COMPLIANCE
Q\.OSL-1"\L\:l V AND UTILITY CONNECTION PERMIT
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Date Rec I d
I. While File
2. Pink Cily
) Yellow Applic.nt
I PERMIT NO. (J7 0(0 10
1
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H-Di\~OV\ TrCLll
ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
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OWNER....,--
(Name) \ l WI
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(Phone) q ~ 1 ,'tLf (). b ~ Lfl
(Address)
lJUILDER
(COmpanYName)CV(\V\.q.tv' et.tfYl(){~ \LlC/
(Contact Name)
(Addres~ rcD~
(Phone) tIj s, L ,Y LfO . l 01 t1l
(Phone)
TYPE OF WORK 0 New Construction DDeck DPorchjij'Re-Rooting ORe-Siding DLower Level Fimsh 0 Fireplace
OAddition DAlteration DUtility Connection 0 Misc.
CODE: DI.R.C. OI.B.C. PROJECT COST/VALUE s k'l;DO
Type of Construction: I II ill IV V A B (excluding land)
Occupancy Group: A B E F H I M R S U
Division: I 2 3 4 5
I ht'reby cenify that I have furnished information on this application which is to the best of my knowledge true and correct. I also cenify that I am lhe owner or authonzt'd agent for the
above-menuoned property and that aU construction will conform to all existing state and local laws and will proceed in accordance with submiued plans. I am aware that the building
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'gnature Contractor's License No. Date
Pennit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
$
$
$
$
$
$
$
$
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
#
#
I Paid .
Date 7/ L1.("7
I :~ce~o .$q ~2 C-
1
ThIS is to cenify r althc 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 lhe City Planner constitutes a temporary Cenificate of Zoning compliance and allows construction 10 commence Before occupancy, a Cmificale of Occupancy must be
issued.
Planning Director
Date Special Conditions. if any
24 hour nolict for all inspections (952) 447.9850. fax (952) 4474245
16200 Eagle Creek Avenue Prior Lake, MN 55372