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�, �� CITY OF PRIOR LAK� BUILDING PERMIT, Date Rec'd
�� �1 � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� AND UTILITY CONNECTION PERMIT ��' �'��
�
�
2. P nk ��ry PERMIT NO. 7 /
3. Yellow Applicant / V - ! � (
lease e or rint and si n at bottom
ADDRESS ZONING (oe'ice use)
�5l o c. �! �
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) V 7 Ci�Li (�t A-- �� �7�-�✓11 (Phone) �l`S'� ���]' — c� 7d-�.
(Address) �
BUII.,DER ' /
(Company Name) � � �""��� d U � /�/ (Phone) 7�0.� � c3 �/ � 760
(Contact Name) ���� �' �%�'lJLV (Phone) 76-3 � c} �`��
(Address) J�� ri/C �-v% On/'TI CCZL.�'j N S.s�o2
TYPE OF W�RK ❑ New Construction ❑Deck ❑Porch �2e-Roofin �Re-Sid'
g u�g �Lower Level Finish ❑ Fireplace
❑Addiuon ❑Alterarion ❑Udlity Connection
CODE: ❑I.R.C. �I.B.C. ❑ Misc:
Type of Construction: I II III N V A B J ,
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE S f`'�/ dD ZS
Division: 1 2 3 4 5 (excluding land) ��
I hereby certify that I have fumished informarion on this application which is to the best of my knowledge true and correct. I also ttrtify that I am the owner or authorized ageM for the
above-mentioned propetty and that all wnswclion will rnnform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revok� this pe nit for just c se. Furthermore, I hereby agree that the city official or a designee may eater upon the properry ro perform needed ins ections
X �� � � G G 35� � l 0 3� �--
Signature Contractor's License No. 1 ate
Permit Valuation Pazk Support Fee # a
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplacc Permit Fee $ TOTAL DUE $
This Application Bernmes Yonr Bailding Permit When Approved Paid �— Re 1 t lvo.
Date � (e . � Z� B
Buildin Official Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may procced as requested. This document
when signed by the City Planner wnstitutes a temporary Certificate of Zoning wmpliance and allows wnstruction ro commence. Before occupancy, a Catiflcate of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 DakotA Street S.E., Prior Lske, Minnesota 55372