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of PR./04, CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
U y; .. TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 8 Z5 to
AND UTILITY CONNECTION PERMIT
M �ivNESO 1V
1. White City i
2. Pink C PERM / O 7 / IT NO V
3, Yellow Applicant i Gam•
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
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A/ ri 4 .—
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER \ '
(Name) `J l r�vNO S .i c 6/ ` -- (Phone) � f-Z y 4 ' 7 — 41 P'Z 9
(Address) 4/ g/ ak 4 Cee 7E v. -t/£ 44et7e. 1 . 4 # E. .41.A1 SC 3 7
BUILDER
(Name) Lci€9V/ : '((4 (Phone) 7S d"1 `
(Contact Name) �/e , r. c-61 (Phone)
(Address) /0 c ( d 4_, 4 ,....c ,&' . I,. itAio/S r /N tir S Sq.,n,
TYPE OF WORK ❑ New Construction ['Deck ❑Porch - oofing ❑Re- Siding
['Lower Level Finish ❑ Fireplace ['Addition ❑Alteration ['Utility Connection
❑ Misc. PROJECT COST /VALUE (excluding land) $ /U ! ' fU p
I hereby certify that I have furnished information 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 existing state and local laws and will proceed in accordance with
submitted plans. I am aware that the building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
enter upo to perform needed inspections.
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--- OW) 6 37 Lib/ 3 'li - itv
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ 7f 75
This Application Becomes Your Building Permit When Approved Paid e. 2h JO Rec t No. , / 0 q'
Date 7 7,7i- B /
Building Official Date 7 I • 7 �
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
f1' 4 PP tY g Y P 4
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate 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