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Date Rec' d
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
7 2/. ()~
I. White
2 Pink
) Yellow
I PERMIT NO. O~.()854'
File
City
Applicanl
ZONING (office use)
5~04 b 5(",0(,..
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
(Phone) q 5d - Lf.~n - &-6 4- ~
OWNER --.
(Name) ~ \ ~ -rr -e......l &+ ;...~l
(Address)
PID z5". OIl. 011,0
BUILDER .s' L., .
(COmpanYName)~ru;Jer L-~+~r/IY$ ,lLL
(Contact Name) fu\.J.'\.-\ Sd.-I"("\pse_\
(Address) P, 0. ISo ~ 1'"""
(Phone) ~9 - 4-\f-O- 1'111
(Phone) cq Sd-. -Jt-'?)4 - loS~ I
TYPE OF WORK 0 New Construction ODeck o Porch ~e.Roofing
OAddition OAlteration DUtility Connection 0 Misc.
CODE: OI.R.C. OLD.C.
Type of Constmction:
Occupancy Group: A B
Division:
I
E
II
F
I
ill IV V A
HIM R
2 3 4 S
ORe.Siding OLower Level Fimsh 0 Fireplace
s ~&CD. 00
B
S U
PROJECT COST /V ALUE
(excluding land)
I ht'feby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certifY that J am the owner or authomcd agent for the
above.mentloned property and that all construction WIll confolm to all existing state and local laws and will proceed in accordance with submitted plans. J am aware that the building
official can revoke thi~ cause. Furthermore, J hereby agree that the city official or a designee may entel upon Ihe property to perform needed. In'pectlnn,
X ~ l.L . &...>r\ ~ o~, 5+ -5..)1~JOv
1 ' Signature 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 $
This Application Becomes Your Building Permit When Approved
Buildin!! Ollicinl
Dnte
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
ThIs IS to certify thaI the reque't 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 the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence Befole occupancy, a Certificale of Occupancy must be
issued
Planning Director
Date Special Conditions. if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372