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�� �� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec' d
� (`� �� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE j �
"� — i� "' AND UTILITY CONNECTION PERMIT ` �. I
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, �°" ��` PERNIIT NO. � Z [ I
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ease or ' aod ' at bottom
ADDRESS ZONII�TG �aes« �)
e � � _ti l t�.� sl.� S 1.1�'��- ���
LEGAL DESCRIPTION (offioe use oniy)
LOT BLOCK ADDITION PID
�� ��` �� - ��.% �, _., Y � - �" ``" � �° i (Phone) � � �.�` l.-� �--� � � l / ��
(Address) � �, 1�1 �
BUII,DEB
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORS ❑ xew Onect Dpa�r1, pxe-Roofnoe O�-siaiog O�.ow�e* �x�et Fmian ❑ Fireplaoe
�Addil�on E]y►�taatia� [�Utifity Comectian
CODE: �I.H,C. �I.B.G ❑1� C G�I�/�G�OW
T�pe of Cone�act�n I II II[ IV V A B
Occopaney C�+owp: A B E F H I M B S U PHOJECT C06T/VALUE � -
•� 1 2 3 4 S (eulodi� land)
I ' that I bave t�s applica�an vohich ia �o the best dmy Imo�rieA�e frae and aaoed. I alro canifg tLn I� We owae[ ot �hoo�ed sgat for tAe
that #il � w� cn�o m6hng s�e aod local iavvs and wHl prooeed "m a000tdaaoe wilb �eQ I am �u tae 6aiida�
'� j , I h� the dty oa'ioal or a de� may e�et upan We psopeity �o pa� x�eded .
ptu .
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COffi!dC[OI�S L10GOSG NO.
Permit Valuarion Pazk Support Fee # S
Permit Fee S SAC # S
PJan C6edc Fee S Water Me�er Size 5/8"; 1"; S
StaLe Stuthar�e S Preuure Reduoer S
Penalty S Sewner/Water Connaction Fee # S
Plumbing Permit Fee S Water Tower Fee # S
Mechanical Permit Fee S BuiWer's Deposit S
Sewer & Water Permit Fee S Other S
Gas Fireplaoe Permit Fee S TOTAL DiJE S
T� wppN� Eecomes Yo� � Pt�c whea w�CUaea Paid ' No. /
Date 3 � 3 i
Buildin OttScial Da�e
Th� ic oo a�l'y a�at me mpuat in �ee a6o.m apptiotion aaa �oompmymg aoc�aa ie in aocad.aoe wdh me CSty 2aoieg ord'mmae ma mry prooad as reqsalea. lfis aowme�
when si�od by t� C�y Pla�ner o�timoes a oemparary Cati6woe af Zooing aoaopdaaa aod alluws oaosaactiafl b aommeaae. Beiae oocapaocy, a CemRwRe af OaYp�ocp �et be
iuued. �
Pl�s�g D'aec�r Dre Speeid Ca�ilias. if�y
24 b�1' rsltoe isr 1A �ectla� (9S2) �477 �f3� 61(95Z) �47-�245
461611aiW� 9trcd S.E.. Prisr laloe. �ash 56372
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