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o � pRlp� CITY OF PItIOR LAI�E BUILDING PERMI�', Date Rec'd
�, � TEMP4RARY CERTIFICATE OF ZON�NG COMPLIAI�ICE
� � AND UTILITY COI�INECTI4N PERMiT �
U � . _ .
��NNES��r [. Wlute fli e PER1VnT NO . /L "/�� � C�
z rmt a�r
1 Ydbor App6cmt � �
leasc or and si at 6otto
ADDRESS - ZONING cot�ce use)
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LBGAL DESCRIPTI(3N (o#�fice use anly} �
LOT BLUCK ADDITION � PID
owrnaR � c�. .
(Name) ✓�4 � - (Fhone)
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BUII.DER -�
{Company Name) �rJ Ck Sd� �U i�{i n a _.L_�l C (Phone) b S�' 0 y� - 9�3 9
(Cont�ct 1�tame} L� e � r r kSOrt � (Phone} b$" �- a ob -� 3 9 y -
t��are�� ad lr'� ve �ac it1 s aS
TYPE OF WORK ❑ New Consnvction �Deck �Porrh �R�6ng pRe�Siding pLoa�r I.evel F'mish ❑ Fireplaa
❑Addition �Alterati�at �Utility Connectto
CoDS: C]I.R.C. C�I.B.C. � i " I '�
TyQe of Constrttctlon: I II IQ N V A B pgp�� COSTlVAGUE S � �� ��'
Omipa�ecq Group: A B E R H I M R S II ta�ding laa�
Division: 1 2 `3 4 5 "
14aeby cer6fy tbac t f�awe Curni�ed iaComwtiaa on this appikatton wtacL is w the beu oFmy knowkdge uoe and rarra. I also ce�tify that I am the ownn � aotlmriacd agcat for the
abovc�mentqned ait eautrdctiaa wiit conto�m to a!1 acistiag smce aad iocai laws and wll p�+ooeed in accordance witL snEmiritd piaos. [ am awar+r �hat the bnifding
og'u�iat pn e thispena�N for" cause. 1 haebp agFee N�at the cdY oH'teiai or a desigaet a�+a�tcrnpa� the paopcRy ro pc�tocm ntedcd i�etttons-
- BCl 9 sv a 9 �a
X � '� �a
. Signa tiac0o�s Licenu No. Date
Permit Vaivation Park Support Fet # S
Permit Re� " S SAC # S
P1an Check Fee $ Water Meter Sizc 518"; i"; S
State Suncharge S Pressure Reduoer S
PenaiEy $ Sewer/Water Connec[ion Fee # � S
Plumbing Permit �ee " S Watcr Tawer P� # S
Mechanical Fermit Fee S- Builder's Deposit S
Setver Sc Water Permit Fee S Odter $
Gas Finpiace Permit Fee S ' TOTAI. DUE �`
.
This Agglicatla� Baomes Ya�rButtdiag Peimit Whea APP� Paid �,' R�eCe t O.
Date B
Suiidin Ot�ciul Date �
Th�s is w catifjr that tAc request iq ttK a6ove app�icatan and a000mpanyiag docummts is in aecordance with the �ryr Zoning Otd'manoeand map pracrcd as n+qurstod. lhis docnmrnt
whea sigoM by ific City Pi�►ner eaatitmes a temporary � of 2ex�ina wmpGznce and ai�vns eonstmc6on tn commena. Hetore uc+cvpaneY, a Ccctificate uf Ooropaney mnst be
issded.
PI rxto�r ' � if m
Z�i hour aoticc tor ap ittspeNious (95� d47-98.�0. hx f'1Stl 447-4?.iS' .
46�t6 Dakota Street P�r Laka, MN 55�12