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a � pRto�, CIT� OF PR.IOR LAKE BUILDING PERMIT, Date Redd
� � TEMPORAI2Y CER.TIFICATE OF ZQI�IING COMPLTANCE
� � . - AND UTIL.ITX CUNNECTYOIY PERMIT
��'VNESO !. Nhite Fte -.
Z. �,,: �, PERMIT NO. � � . � (�
3 Ydlow AppNoN
tease ar iint and si at bottom
ADDRESS . ZONING (ot6ce ux)
L� , i _
LBGAL DFSCRIPTION (otl&ce use only} " . .
LOT BLOCK ADDITION � PID
OWNFsR
(Name) Y V� �.; - (Phone) � 17 Z,� �- � j- �,�Q 1 �
cAa�a�� q.r-j "� T�r �\ �. rn1U 5��� Z
BUII.DER �
(Company Name} .�r'i Ck so �U i,� d; ^� rl C. (Phone} b sl- a�r� - 9�? Q
(Contact Name) eG � r'i c ks'Orl J b SI - ao6 - i 39�
(Phone) .
�aaa�s) ad 6 ,c,c c�� ve P�c�e scf/ aS'
TYPE OF WORK ❑ New Cocaduction ODxlc Qporch �te-Raofing �Re,Siding OLowe� Levei Finish ❑ Pireplaa
�Addition OAkeration DUtiliry Connectian
CODE: QI.RC. (]I.B.C. ❑ M�- '
T�+ge of Constraction: I II III iV V A B pgOJBCP COSTtYALIJS $� J�� � �
Occapancq Gronp: A B E F H I M R S U {��� � � � �
Divlsion: 1 2 1 3 4 5 g�� -
i 6erd�qr ce�tify tl�t i have tumisl�d inCormatroa an fleis appa'ieada� abidi is to 1he 6e� of my imoarkdgt hue m�d anzrect. I aim ctrtify tl� t am the awnec ar aatiroriacd agent tor tite
above-mentioatd aad that a!! coa�savc4on wiri codfam m all exisqng sqte aad local laws a� wll pcaceed in aceadanee with snbmitted pEans. [ am awue tlwt tfu 6nitd[ag
o&c�t can u �rjust ause• Krmorc,l henbY a�ee tl�at the dty ofliciat or a dsigqec mry autirapan ti� a
- _ P�Y P�+� netded it�ettions-
X J9sv a9 _ s
� 5 ��� ConlrscW�s Lic�ense No. Date
Permit Vatuation Pazk Support Pee # a
Permit Fee ' ' $ SAC # $
Plan Check Pee S Water Meter Siz� 5/$°;1"; $
State Snrctiarge S pressure Rednrer g
p����l' 3 Setiverr/Water Connection Fee # � S
Plumbing Permit Fee ' $ Water TowerFee # $
Mechanical Pesmit Fee S- Buitder's Dep�it �
Setver & Water Penmit Fee S Other $
Gas Fireplace Permit Fee S TOTAL DZIE $
Tlds Applicadon Ba:omes YoncBulldtag Prnnit WLsn Approved pazd ' t NO.
Date �� . t
Buitd'in Ofticigl Date
Th�s is to catify that thc roquest ia ehe above appticat�n and aoo�anyipg docu�ats ic in acc�dancc wit6 the (5tp Zdniag Ordiom�or aid maY Pmcocd as �tcd. Tws dacument
�vhco signed by tlu Ciry Pianner rnnstitMrs a tempora�y Crrtit'raM af Zonin6 oompliame and aflows consuuction to toena�pue. Befior+e
issved. ocrupancY. a Certificatc uf Oocupaacy most 6e
Pianning DT�ectot " Due (�d'iGwu. if m
24 hour soticc for ali tnspections (952; d41-4S�D. t�ex �S2) 4�17-424.i"
4646 Dakota Sh� PrIor Lef�e. MN 55372 .