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��f�PR�'�� CITY OF PRIOR LAI� BUII.,DING PERNIIT, Date Rec'd
� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� / �' �
�, AND UTILITY CONNECTION PERMIT
�-
- �
1. White File pERMIT NO .
2. Pink City �� J� ��
3. Yellow Applicant
- ease or ' and si at bottom
ADDRESS �� � / S ' ,1 ZONING (otrice use)
/�-E' /K / U� /l.� G/`i
LEGAL DESCRIPTION (oflF'ice use onty)
LOT BLOCK ADDITION PID
OWNEB C'� D` `J�U�N �.��
(Name) � (Phone) /•�� ' "y y 7 - ! �� �
(Address) � ! nC'J� �� J 7�
BUII.DER ) '/
(Company Name) 4 (Phone) l�.s � - 7� �,�� `�
(Contact Name) Ll ' (Phone)
.
(Address) Jlp � , �Q � � /
- TYPE OF WOBg ❑ New Construction �Deck OPorch �Re-Roofing e-Siding �Lower Level Finish ❑ Fireplace
, ❑Addition DAlteration ❑Utility Connection
CODE: ❑I.B.C. ❑I.B.C. ❑ Misc:
T�pe of Canstinctton: I II III 1V V A B
Occnpancy rrroup: A B E F H I M 8 S U PROJECT COST/VALUE S 7,, y�/' �,��
Division: 1 2 3 4 5 (ezclnding laad)
I hereby certify that I have tLrnished information on this application which is to the best of my ]mowledge trut and coaect. I also certify tltat I am the owna or suthorized agent for the
above-mentioned property and that alt construction will conform to all eatisting stace and local laws and witl proceeed in aaordance with submitted plans. I am aware that the boildiag
officiat can rev tlris pe ' or �ust caus . Furthermore, I haeby agee that the city official or a designee may rnter upon the property W perform needed inspectiona.
X ��� ���;�� _ C�CC�/ ry� //- � J/�
Signahuc Contractor's License No. Date
Permit Valuation Pazk Support Fee # S
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surchazge $ 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 Fireplace Permit Fee $ TOTAL DUE $ ?' � 7�
��'►rr��� �� Y� �� p� ��� Paid Recei t
Date ! I lY B
s��a;n ot��;� Dac�
This is to certify that the mquest in the above application and accompanying documents is in acwrdance with the City Zoning Ordinance and may proceed as mqnesbed. This document
when signed by the City Planna consfltutes a temporary Certificate of Zoning compliance and allows construction to oommence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Dirxtor Data Speciel Conditions, if my
24 honr notice for all inspecttone (952) 447-9850, �az (952) 447-4245 '
4646 Dskofa Street S.E., Pr[or I.alce, Minnesota S�i72