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��j'�`� ; 9 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec' d
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" � �' AND UTILITY CONNECTION PERMIT
� ��'
f NN � SO
'. "',�`° F`�e � pERMIT NO. — I� 9 7
z. r�a� c�ty �� /
3. Ydlow Applicant I
ease Or ' Y and ' at bottom
ADDRESS ZONING �ot��,�>
�j �� r �� I �I'�'��1 L-(� (�'� r` l �� � 1. I �t) .
LEGAL DESCRII'1TON (oflice use only)
LOT BLOCK ADDITION PID
�aWNER ���� � �V � � (Phone) " I C�'� � 2��� '"� � ��
(Address) ( '` (�. I� �J 0 (�. � � � �
(C jN� ��������(��l � � (�� (' 1 (Phone) �P � L �✓ �7� ��'Z�
(Contact Name) �+R'1�� ,n� ��SO� (Phone) I /) I 2 IQ3�0 (I"f �
�Aaa�S� �Lbo S 3 fi in( � �1
TYPE OF WORK p rrew eonsm�ceion �Dec�c []PoCA�e-Roofing �Re-Siding �Lower Levet Fiaish ❑ Fircplace
�Addition QAlteration �Utility
CODE: (]I.R.C. �I.B.C. ❑ Misc:
Type of Com4tn�ction: I II III IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE S��1 D�C�, ad
Di�ision: 1 2 3 4 5 (excladinyr land)
I hereby ceitiFy that I have fi�nished information oa d�is applica6on which is ro tt� best of my knowledge uue and carmt. I aLso cert� that I am the owna � audimized agent for t6e
abwe-m�tioned pmperty and that all consaucfion will confoim to all existing state and local laws and will procecd in accordance with submitted plans. I am aware that tIle building
offiaai revoke this pe«mit for jus cause. Ftiuthermore, I hereby agree that the city official or a designa �y enter upon Me p�operry to peiform needed inspections.
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x 1 '(�'��380�� ( I2
Signature Conuactor's License No. te
Permit Valuation Park Support Fee # S
Peeznit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; �
State Surcharge $ Pressure Reducer S
Penaity $ Sewer/Water Coaneccion Fee # �
Plumbing Peimit Ree $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer 8c Water Permit Fee S Other S
Gas Fireplace Pemut Fee $ TOTAL DUE S ,,�
TLis A�on Becomes Yom� � Pergit Wlrca A�rored PAitl � RCCC� t o
Date L B
Buildin Official Date
Tfus is to certify that the irquest in the above application and atxoa►paaying documents is in accrndance with the City Zoning Ordinance and roay piviceed as requested. This documaat
when signed by ffie City Planna constituus a tmoporary CecdHcau of Zoning compliaace and allows coasuuction to commence. Before occuPencg� a Certificau of Oxupancy must be
issued.
Planning Director Date Speciat Conditions, if any
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