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CITY OF PRI�R LAKE BUILDING PERMIT,
�r' /;� ��, �e^
�,; � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ��,
�, , i � � �� �
� �,� ;'�__`�� `�' AND UTILITY CONNECTION PERMIT � , � � ' � �
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�NES�
1. Whitc F��e pERMIT NO .
2. Pink Ciry /�� ,�
3. Ye(law Applicant ! � o ..
lease or ' and s' at boitom
ADDRESS ZONING �o�� „��
/�`� � ��a S� 1�.�'Utl � ��� ��
LEGAL DESCRIPTTON (off'ice use only)
LOT $LOCK ADDITION PID
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OWNER / �
(1Vame) �21c r�7 ^ �'6�!`��—`'l � (Phone) ��� � ,2., �3. °` 1 ,/
(Address) e. Q ,S �' � �
BUII,DER I t !� GK �� rR' O�'1 � I 2• Z S 1� 7��
(Company Name) � g a/ '�� � (Phone) 7
(Contact Name) SD � r1G �r ,/�� - �' 77', ���C� (Phone) G j Z- Z 6 7•� 3/ b
(Address) � `� /Jf, � Ii� .5�.3
TYPE OF WOILK ❑ New Construction �]Deck ❑Porch .�Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
�Addition �Alteration �Utility Connection
CODE: []I.R.C. [�I.B.C. ❑ Misc:
Type of Con.�tracrion: I II III N V A B qu � s�
Occupa�cy Group: A B E F H i M R S U PROJECT COST/VALUE S << ��
Divasion: 1 2 3 4 5 (excluding lan�
I hereby certi�fy tliat I have fiunished information o� this application which is to the best of my knowledge true and coarect. I also certity d►at I am the owner or autl�orized agent far� the
above-mentloned property and that all amshuction w�71 mnfrnm to all eaisting state and local laws and will proceed in ac�rdance with submitted plans. I am aware thai the baiiding
official can rev this permit for just . Furthecmaae, I hereby a�ree that the ary official ar a desigiee may eater upon the property to perfoim needed impations.
x l�C.. �'3S�SS,� � �?�o� 1 �
Sigoature Contractor's License No. Date
Permit Valuation Pazk Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reduoer $
Penalty $ Sewer/Water Connection Fee # S
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee S Builder's Deposit S
Sewer Sc Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE �
'i'his Applic�ion Becomes Yo�a Bu�diag Peimit Whea Apptoved P31d. i t No.
Date Z Z Zi
Builain Official Dade
This is to ce:tify that the mquest in tfie above application and acmmpanying docvments is in accordance with the City Zoning (hdinance and may proceed as requested. This document
when sigued by the City Planner constimtes a temporary Certificate of Zoning compliance and allows mnst�ucdon to commence. Beface occupancy, a Ce�tificate of Occupancy must be
issued.
Ptanning Director Date 3Qecial Condilions, if any
24 hour notice for all inspections (952) 447-9850, faa (952) 447-4245
4G46 Dslcota StrePt SE., Prior Lalce, Minnesoffi 53372