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o�- PR1 ��P CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE / e,�/. � Z—
� D �' �ND UTILITY CONNECTION �ERMIT
� ��
j �'NES O
1. White File pERMIT NO .
2. Pink City � � . � � ��
3. Yeltow Applicant
lease or ' a� si at bottom
ADDBESS ZONING �o�,�>
1� 2 3 C.o L��e.Stc�'.-� ,�4 �� ��
LEGAL DESCRIP-TION (oHice use onty)
L-OT - BLOC� ADDITION PID
OWNER /�� ` ' �45z� t^l � `l — 2 b 8 (o
(Name) /" Y� �-�-�� c.�-� 6' � r1S'�J� (Phone)
(acidress) ` � 2..-'�Co L��S L� •�� ��
BUII.DER C � S ,� u � � � S
(CompanyName) � °-' (Phone) l� 1 �- (c`{S `3 �
(Conta.ct Name) �� � �l �'�1 (Phone) t-.� t ^ �l'�l c� '�- �o S �o �2_
(Ada�s) S 3��.� S��,1-e,�-� � S-� �.�.� 1 l�'�'�.� S t l?
TYPE OF WORK ❑ New Conswction ❑Deck �Porch ❑Re-Roofmg ❑Re-Siding �Lower Level Finish ❑ Fireplace ��i � L+ �
DAddition �Aiteration ❑Utility Connection
CODE: �I.RG �I.B.C. ❑ ��: �'� ����� � � � �� � �'
Type of Coffitivcbon: I II III IV V A B L 1
Ofca�am.y Gmo�: A_ B E F H I M R S U PROJECT COST/VALUE S � t `� 3
Division: 1 2 3 4 S (eacluding land)
I hereby certify that I have furnished infarmation on this application which is to the best of my knovvledge true and coirea. I also catify that I am the awner or autha�ized agent frn' the
abrn�e-mentioned property and thaz all construction will couform to all existing state and local laws and will proceed in acoordaace with submitted plans. I am aware tbat the bwlding
official caa reuoke this raase. , I fiereby a�ee that the dty offidal or ades�ce may enter upon the pmpeity ro perform needed inspections.
X 1� e._, 5��-�! '� l`� ��/ � t l i z.
gignature Cont�actor's License No. Date
Permit Valuation Park Support Fee # $
Pe�mit Fee $ SAC # $
Plan Ch�k Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
p $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer 8c Water Peimit Fee $ Other $
Gas Fireplace Pennit Fee $ TOTAL DUE � $
1$is-Apgluatiert Becomes 3four Bw7ding Permit When Apprnoved ��d • R t No.
Date /v . //, �z. B ,
Buildin Official Date
This is to certify that the request in the above application and accompanying documents is in acmrdance with the City Zoning Ordinance and may proceed as recNe�d. This document
when s�ed by the City Planaa mastitutes a temporazy Cereificaze of Zoning oompliana and allows oonst�ucdon bo oommence. Befare oavpancy, a Certificate of Oaupancy must be
issued.
Planning Directa Date Special Conditia�ns, if a�ry
24 6our notiee for all inspectioes (952) 447-9850, fu (952) 447-4245
4646 Dakota Street SE., Prior Lakq Mianesah 55372
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