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o � PRl�� CITY OF P1tIOR LAKE BUII.DIl�IG PERNIIT, Date Rec'd
,� ,� TEMPORARY CERTIRICATE OF ZUNING COMPLIAI�ICE
� � . . AND UTILITY CONNECTIUN PERMiT . .
'��NNESO'�" '.'�;'° �° PERMIT Nt�. r � �
3 Ydbw A�ant � '_T � � > �le� � `-' ►
lease or r1aE and si at boito �
ADDRBSS - Z�NING (ot6cc usc)
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LBGAI, DESCRIPTI4N (ofl&ce use only} � � �
LOT BLOCK ADDITION � PID
�aW�NBR/�l. � P �l G �, � '� �C1� W'���/l � p � �.�i t�- (Phone) "c �2-' �.'� �j� — C C� ( �
(Address} � �JO '�Yu � l /�'`1J
BUII.DBR -�-�
{Company Name) �f 1 Ck Sdr1 �U 1� �� _.L_�1 C (Phone) b s>- a�a� - 9 J�t�
(Concact Name} C,� G � f 1 f kSOr1 `� (Phone) b s� a ob -� 3� .
c�) �d �r� ►.e P/ N ss� as
TYPE OF WORK O rrew ca�strtMtion Dnak �rorch -xoo6ng �Rc,s��iug pi.ovrcr r.evc! F"in;sh p I�'ir�enlaee
DAddirion ClAltecation DUtility Connation
CODS: (]I.RC. C�I.B.C. 0 �'��' -
TyQe of Constncccion: I II fII IY Y A B pgOJECT L'OSTfYALUE $ �� r��
Occupancy Gronp: A B S P' H T M R S II {� ��
I?ivision: 1 2 �3 4 S �
I ierdy certify tha[ [ have hunished infmmatiaa on thls appl'�xion wbich is ta the best oEmy know�dge 7:ae and correct. i aho ceniFy tt�t ! am the uwner ar aoelmrkod agent toc fhe
�11ovt me+uioaod pmpeny aad t6at aii conswcuon wil! c�niam to a9 existing uate u�d keai lawt and w�t p:ncaed in aocwdartce with submittcd p�ns. I am �taraa lhat du IwBd(ng
aNkiat 1ct6isncm+nFe�iu�.�+�e. L�aMemw�+e.7heabyag�cethactAeatyoEfidai�ada�eema�rouarnpont6epuiope�tybpaformmcdedinspcctions.
X � �Cl9sva9 � �[�� l �-z
.- signaa,re Concracoot's L►cer,se No. nate
Permit Valuation Park SupQort Fee # S
Pcrmit Ree " � S SAC # S
Ptan Check Fee � � Water Meter Siae S/$",1�'� b
State Surdtarge S Presstue Raiuoer S
p���y $ Se�ver/Wat� Connection Fee # - S
Plumbing Pemut Fee - S Water Tower Fee # $
Mechanical Fesmit Fcc $- Buiidec�'s Deposit S
Setver & Water Permit Fee S Chher �
Gas Fireplace Petmit Fee S TUTAL DUS S
Tids appitcatioo Beeomes YourBuri�ng PenmltlYhea APP�+►� Paid " t No.
I?atC
Buitdin ORicisl DaEe
Th►s is w certily that thc re�est ia t6e abore appiication and amompanyiog doeuments ic ia accarda�e with the C'uY ZvninS Or�ime.and may pracrcd u n�ed. Tdis daumeat
w}�a sigaM bp the City Ptanner canstitntes a tempoaa+y Caetiiieale af Zoni»; compliana aad a!lovrs const�ction w commence. Befi�+e oc�paneY. a CMtificate of Ooa�paa�y tro�st be
issued.
1Nrcetar � S� � �ffi
2a hour notice fa aii Inspections (952i d47-48.i8. #u QJSt) �t?-4M9" _
4b46 Daicota Street Pxior Lake. MN 55372
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