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R- 1-0.00 )IO:/f
CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE, '
AND UTILITY CONNECTION PERMIT
(Please type or print aD, d sip at, ~
I ADDRESS
11-/6/ Herrze
I. WIlke File I PERMIT NO
2, Pi1lk City . 0 1 - 4 SQ
) YoIlow Applice.. 0
TrGl \ Sf~
ZONING (office_)
~" I
LEGAL DESCRIPTION (office use only)
LOT 1\ BLOCK '1.. ADDITION V->fSoO,,-V}~6-' est" 1..t-p AOO
PID -ZS.~'t",'-O'''-.o
(Phone)9~)J' LiLI1'c'~
I g,= r-.oln;Y) .} cf-f-'v\(\ rG-r -fox
, (Address)
=~Namel ~~"i> IIVlU<ul !,h<llnL{lio/1
(Contact Name) &.f (~
(Address)6&l// ;J;e/l)()r/a-I At. /Y. "h:'WtLlr.",
(phone) I/Gj.7".:J;C)..y: 3X)
(phone)
.# 6-S() 8'.;L
TYPE OF WORK O,New Construction ODed OPorch ~.Roofing ORe.Siding OLower Level Finish 0 Fireplace
OAddition ~tion OUtility Connection 0 Misc.
CODE: OI.R.C. OI.B.C. PROJECT COST/VALUE S ~JY'3R,00
Type of Construction: I n ill IV V A B (excluding land)
Occupancy Group: A B E F HIM R S U
Division: I :z 3 4 5
I hereby certify that I have furnished information on this application which is to the best of my knowledce trUe and correct. I also certify that I am the own~'l' or authorized agent for the
above-mmboncd property and that aU construction will COlIform to all existitl& stare and Iocaliaws and will proceccI in accordance: with submitted pians, I am aWare that the building
offici can e this -I for just cause, Fu et1IIOl'C. 1 hereby a wIthe city official or a designee may enler upon the property to pcrf'orm needed I~ions,
~C/ 5? d-y' F-Y' ViI (;; ((~
Contractor's License No. Date
x
Permit Valuation "2-4:\1")0. -
Permit Fee $ 14.,"'-
Plan Check Fee $
State Surcharge S l. 'L<"
Penalty S
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee S
s Your ~uildlnl Permit r tpprond
j/s /01
Date
Park Support Fee # S
SAC # $
Water Meter Size 5/S"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # S
Water Tower Fee # S
Builder's Deposit S
Other S
TOTAL DUB $ '1{g -
I Paid
Date
1~%1
I
I ~;ceiPt NPrIi~f
ThIS IS to eenify thaI the requesl in the above application and accompanying cIocumenlS is in accordance with the City Zoning Ordinance and may proceed as requcsted, This document
wllcn signed by the City Planner constitutes a temporary Certillcate of Zoning compliance and aUows constrUction to commence, Before occupancy, a Cl'l'tiflCalC of Occupancy must be
issued.
Planning Dim:lor
Date Soec:ia1 Coaditions. if any
24 hour notice for al1lnspntionl (~:Z) 447-9850. fax (~:Z) 447-4:MS
16200 Eagle Creek Avenue Prior Lake. MN 55372