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h \� CITY OF PRIOR LAKE BUILDING PERMTI', Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" U� AND UTILITY CONNECTION PERMIT
�
1 `VN E 50 't
2: � F=,ry PERMIT NO.
3. YetL7w Appticani �� � /� �
PICd3t 02 � 3� �t�lOtbDtti
ADDRESS ZONING (ott ��)
J�1� C'xn C Pr°�,or t-ar.�
LEGAL DESCRIPTION (office use onty}
LOT BLOCK ADDTTION PID
OWNE j�.�
{Name) I rQ�C .� J�����r' c�one� � ia - a�a - y�Sc�
(Address) 7� � � 1.cx� rn �s 3�a
BUII.,DER � --' y -�
(Company Name) C QX'C�r wu c,�� (1��, LYIC . {Pbone) �'� Z ' �� '" � 6 38
(Contact Name) � �� S�' (Phone) � ( � 3 � � - S/ 61
(Adtiress) �! j D 1� r nr Dus'�l F3c.aa � S S oPE� i s 3
TYPE OF WORK ❑ New Consuucaon ❑Deck QPorch ($�te-Roofing �Re-Sid"mg �Lower L�wel Finish ❑ Fireplace
�.4dda�ion �,41tr.ra.tion �Utility Con�ctic�n
CODE: DI.R.C. QLB.C. ❑ Misc:
Tppe of Consmicaon: I II IIt IV Y A B
Oa�pancq Gnoup: A B E F H I M R S U PROJECT COST/YALUE S �'
Divislon: 1 2 3 4 5 (excludin� Iant�
I t�+eby o¢xtit� thaz I have furnishad infor�tion on qti¢ appJication which is m du best of my l7wavledge K� and ooirect. I a1� tttt� that I am tlx owna � a.utl�ized a�rnt f� the
above-mentioc�d property and that all wn�xt�n will conform to all ex�dng state and �cat laws aM wili proaed in accadac�e wrth submitted plans. I am awam diat the bui(ding
ot�icial can revoke this peRnit for just cause. Furthecmoce, I hereby a�rree Hut tt[e city otFr.ial or a designee �xy en6er vpoa tlne oa needed '
ee pcopecty pecfocm m�.
X ��,, � a����3�-� r►--� 3-�a
Q Signahue Contracbor's Licsense No. Date
Permit Vatuaiion Park Support Fee # �
Permiit Fee S SAC # S
Plan Check F� $ Water Meter Size 5/8"; i"; �
State Surcharge S Pressure Reducer S
Penaity a Sewer/Water Connection F� # $
Piumbing Permit Fee E Water Tower F� # S
Mechanical Permit Fee S Builder's Deposit $
Sewer 8c Water Permit Fee S Other �
Gas Fireplace Permit Fee $ TpTpi, DL]E $
This Application Beoomes Your Bo�ding Perndt When Approved p�d Recei o
Date —
suil " Ot�icial Date
This 's 6o cettit�+ d�at d� mq�at in die above applica�on a� accompauying docum�ta 'ss in accadanc� widi dre City Zaning Ondiaazwse an�d may piocee� as ie�ed. This document
when sig�ed by the Cixy Planner mnstitaxs a temporary �care of Zoning compliance ard ailaws mnsLrucaKmi Fo ooe�we. Befixe occ
issued. ++PancS', a Cert'ff'rare oT Oceupancy must be
Planning I�ractor Date Spacial Conditiais, ifany
24 honr notice for all inspections (9S2) 4A7-9630, faz (952) 447-4245
4646 Dakota Street S.&, Prior I.ake, Minnesoh 55372