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o� pR ��ip CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� X TEMPORARY CERTIFICATE OF ZONTNG COMPLIANCE I� r ���, �
� � AND UTILITY CONNECTION PERMIT
��NNESa
�. W "``° F PERMIT NO. � - ��
2. P'vmt Chy
3. Yelbw Appliaat
�' 8IId SI 3L �
ADDRESS � � � ZONING ��«,��
�� � 2��{ �1 i�lS �1�0 Ll� l� �� ��r' I� t� l,.C�--f.�.
LEGAL DESCRIPTION (o�a use oniy)
LOT BLOCK ADDTTION PID
(I�Ta�m e ��i �� Va U���1L � l% � I (Phone) �P �� � �J" Q �� -� `l' O ,iCL_
�
(Address)
BUILDER.�-� l ,
(Name) 1 �/�-� �" G✓ ����/�� , j� (Phorn)
(Contact Name) (Phone)
(Address)
TYPE OF WORK p Nea conswetion pneck pPorch xoosng ORe-sidio6
Or.owu r.e�a r� Q F�� OA�aon �nioe�on OUa�nr com►«�on
❑ Misc. PROJECT C�TNALUE (exdod'mg lland) S
i eereby oerHfy chac I have nuaiahea informatlon on u�is applicuion wbicfi is w n�e tesc or my tnowlea�ee we ana aorr+eot. I also oertiry enu I azn ene ov.na ar
a�riud agmt for the abovam�tia�ed property and fl�t all c�onso�action will co�fiotm to all exi�mg atate and local laws and wiri proaM in aoradanoe wilh
submit6ed pla�. I am awane that the build'mg officiai can ievote Wis permit for jast cause. Fucthamwe� I herrby agee thac the aity oi6cial or a deaignee ms►7
enoer upon du property to perform needed iospeetions.
X
Sign:nue Cono�xtor's Liaense No. Date
Pe�mit Valuation � � Park Support Fee # S
Pem�it Fee S �- � SAC # S
Plan Check Fee S Wata Meter Size 5!8"; 1"; S
State Surchar�e S Pressnre Rednoe�' S
Penalty S �ty SAC and WAC # E
Plumbing Permit Fee S Wata Tower Fee # S
Mechanical Permit Fee S Builder's Deposit S
Sewer 8c Water Permit Fee E Other S
Gas Fiteplaoe Pennit Fee E TOTAL DUE S
'reia ' secoma Yonr Bmtaing reemic w6en Ap�roMed Paid ' No. /
' �� - / ��/,' nace —� L B
Building OSiaal Daoe
Thit is to oeni[y dret the rtquat in dee abovc applicatioa aad aocompanymg dowmmts 's ie aoro�daaoe w�lt dx City Zoniog Or�me md may proaed as n�0ed. 'lbis doa�mmR
w6m sigoed bY t6e City Plannrr camsdtuta s nmoporary Ce�iRate of 7ooing co�kance aod atlows conctnution to commmoe. Be[ae occ�PaoeY. a CectiHeaoe of Oavpaocg mnet be
isaed.
Piaming Dinctor Dau Special Conditions, if aoy
�4 hav nWice for all i�pa:tio� (952) 447- ta�[ ) 447-4�45
16200 Eagle Creek Avem�e Prior L.aloe, MN 55372