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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please
ADDRESS
w j l/oWl-V'oe>J s+-5, &-.J
\ t~/tv(
Date Rec' d
7/2 '(4r
I White
Pink
3 Yellow
File
City
Applicant
PERMIT NO'lJl"- 1)5' (){)
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
~e-
s
~ (;) \,V\.?o V\
(Address)
BUILDER
(Company Name)
(Contact Name)
~.~_: '''L- j;\~
.
CD V\A" ')
(Phone)
'52-Lc/ - 2
~,.5.1A/ .
/'
~
~.
(Phone)
(Phone)
(Address)
Z 9-(07)
TYPE OF WORK 0 New Construction DDeck DPorch ~-Roofing ~e-Siding DLower Level Finish 0 Fireplace
DAddition o Alteration DUtility Connection 0 Misc.
CODE: ~LR.C. OLB.C. :}OO DD6 vQ
PROJECT COST /V ALUE $
,
Type of onstmction: I II III IV V A B (excluding land)
Occupancy Group: A B E F H I M R S U
Division: (J) 2 3 4 5
I hereby certify that I have hlrmshed mfmmation on this application which is to the best of my knowledge true and COlTect. I also certIfY that I am the owner or authorized agent fllr the
above. mentioned property and that all Cllnstruction will conform to all existing state and local laws and will proceed in accordance with submlttcd plans I am awarc that thc buildmg
official can revokc this permIt ~ Just cause FlIlthermore, I hereby agrce that the CIty official m a designee may enter upon the property to perform necded mspecllons.
X ~r~- ~:?a!ror~le~e~o~ 7/2iL~r;
Permit Valuation 2.S"'aa a()C)
Permit Fee $ 74. ?~
Plan Check Fee $ -
State Surcharge $ I. "2.-~
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
~~
l3uildtllg Otlicial
:1~~1
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; 1"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ 7 L, 00
Paid
Date
'7~'OO
7 "Lt/oy
Receipt No.5' 1> (
By i1r
,
ThlS IS to certifY that the request m the above applicatlOn and accompanymg documents is m accordance with the City Zoning Ordinance and may proceed as requested. ThIS document
whcn signed by the City Planner Cllnstltutes a temporary Certificate of Zoning compliance and allows constructlOn to commence. Before occupancy, a CertIficate of Occupancy must bc
issued
Planning Director
Spccial Conditions, if any
Datc
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372