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,2-'-1 'L-f:>
PR10 \ i.- ~ CITY OF PRIOR LAKE BUILDING PERMIT,
4fl \ TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please
ADDRESS
at bottom)
17
Wcn[)V,'~
'7
Date Rec;I
1_ ? oY
White
Pink
3 Yellow
I PERMIT NO. 08. 045;1
File
City
Applicant
ZONING (office use)
et,
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
~ \ 'l-ee~L-1NDj n-e r
'73/7 WC1()DYl'tur ch
fr ~h l,Jf
(Address)
BUILDER
(Company Name)
A-'IY\''e,'f ,'c a.tJ
B cA.('lol (' ";J-
(Phone)
9 5J.- lJ'10- 8~) 7
Can 1-(ttctu'c~hOne) q5~ -7tJ 7 - ~ $> s9
r'r\SV' 11 e
TYPE OF WORK 0 New Construction ODeck OPorch ~e-Roofing ORe-Siding
OAddltion OAlteration OUtility Connection 0 Misc.
CODE: DI.R.C. DI.B.c.
Type of Construction:
Occupancy Group:
Division:
V
M
4
A
R
5
II
F
1
III IV
H I
2 3
I
E
A
B
OLower Level Finish
o Fireplace
$ 16. 3~Y!!-O
,
B
S U
PROJECT COST IV ALUE
(excluding land)
I hereby certify that I have furmshed :cnformation on this application which IS to the best of my knowledge true and correct. I also certifY that I am the owner or authorIzed agent for the
above-mentioned property and that all construction will conform to all existmg state and local laws and will proceed in accordance with submitted plans I am aware that the buildmg
:rlc()~ Je.:~ hereby agree that the CI~COO{ ldl3~ 3er upon the propel1y to perform~
Signature Contractor's License No. Date
Permit Valuation
Permit Fee $
Plan Check Fee $
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
Building Ofticial
Date
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $ .,/} I
TOTAL DUE $ /0 --
,
7;.1-dl
I~NO
~J/~
Paid
Date
ThIS IS to certifY that the request m the above applicatlon and accompanying documents IS m accordance WIth the City Zoning Ordinance and may proceed as requested ThIS document
when signed by the City Planner constltutes a temporary Certificate of Zonmg comphance and allows construction to commence Before occupancy, a Certificate of Occupancy must be
ISsued
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372