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��! p I �� CITY OF PRIOR LAKE BUILDING PERNIIT, Date Rec' d
�'� ���,\�'� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
"`,..� ��� � `t' AND UTILITY CONNECTION PERNIIT
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�. �u F��° PERMIT NO �/, �
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3. Ydlow Applicmt
C38t OI 3II11 SI 3[ �fOLI'Offi . .
ADDRESS ZONING (otrioe nse)
1 S �S � �' n r- t5 c�► T/c'
LEGAL DESCRIPTTON (ofl�ioe vse only)
LOT BLOCK ADDTTION PID
� Ray 5fv r� (Phone) L�1 � " a 8 0-`�01 a
(Address) / s/ 5 oZ �,r t�� Ti'� 1��r�,^ !�K F� m� S S 3� OZ
BUII,DER
(CompanyName) S.�i�2C�"�!//'�� Cc��US�vG�ia,tl (phone)1s�5! 2�9 3r �
(Contact Name) c�iJ �2�' (Phone) �`-� � 5 9 a 40 7 q
(Address) l� Ger Gz�/'�/P ��-� �'�• ��J � h'1 � 5� I�O' .
TYPE OF WORK ❑ New Construction ❑Deck �Porch �e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fircplaa
�Addition �Alteration �Utiliry Conncction
CODE: DI.B.C. �I.B.C. ❑ Misc:
T�pe of Construction: I II lII N V A B
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE S��
Division: 1 2 3 4 S (excludit�g land)
I haeby ce:aty that I Lave fiunished infom�aoon on this appflcation wltich is W the best of my lmowkdge tnu and coirect. I aiso catity tLat I am �e owna or authorized agtnt for the
above-meationed property and that all oonst�uction will oonform to all earistiag stau and local laws aad will proceed in acoordana with submiued plans. I am aware that the building
official can revoke this pecmit for just use. ecmore, I hereby agree tLat ehe city offidal or a designee may moer npon the propury to perfoim needed inspedions.
�s �-7 a G�o � -1 � � � � .
Sigiature Contractor's License No. Dau
Permit Valuation Pazk Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Metex Size 5/8"; 1"; $
State Surcharge $ Pressure Rsducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fce $ Builder's Deposit $
Sewer & Water Pernut Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $
This Application Beoomes Yo� Building Permit What.Approved Pald � No.
Date S B
Buildin Official Date
This is to ceitiPy that the nquesc in the above application aad aarompanying documeass is in aacordana with the Ciry Zoning Ordinan« and may pmceed as requested. This documect
whea signed by the City Planner coastimtes a oemporary Catificate of Zoaing compliaaa and allows conshudion to c�anmence. Refore occupancy, a CerliScate of Oavpancy must be ,
issued.
Planning Direcror Date Special C�ditions, if �y
24 hoar notice for all inspectloos (932) 447-9850, faa (952) 447-4245
4646 Dakota SMet SE„ Prior Lalu. Minnesota SS372