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o � rR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
�',�,�� �. Wn��e File PERMIT NO. � L
2 r��� c�� � � q .
3 Yeilow Applicant
Pleasc or 'm and ' at bottom
ADDRESS ZOI�TING {ot�'ice use>
��- 3 `� s a;l 5.�,
LEGAL DESCRIPTION (office use oniy)
LOT BLOCK ADDITION PID
OWNER -
(Name) � � `( �� �1Y�GL �d�C f �S (Phone) 9� a � � �6 '' �� T a'
(Address) �'
BUII.,DER � � � I- �- ^� U
(Company Name) 'ncCr-GWQ.Q. � �in��fS2�7 (Phone) l��'0����7 ���
(Contact Name) (Phone)
(Address) ,q p'� ��Q , ��C '� �JU� O V i �. N SS � �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roo6ng ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connectio l � y �� �� (,� � ^ �� ��}�(`Q
.--�
CODE: ❑I.R.C. ❑T.B.C. dMisc. ��'� •
Type of Construction: I II III IV V A B pROJECT COST/VALUE S �� ��� �
Occupancy Group: A B E F H I M R S U (exciuding land)
Division: 1 Z 3 4 5
I htreby certiCy that I have fumished information on this app(ication which is to the best of my know►edge mte and conect. I aiso certify that 1 am the owner or authonzed agent for the
above-menCioned property and that a(1 evnstruction wiil conform ro atl existing state and tocal laws and will proceed in aceordance with submitted pianx. I am aware that the buiidm$
ufficia n revuke this per it for jusc cause- Furthermore, 1 hereby agree that the city official or a designee may enter upon the property to perform necde spcctii�ns.
X �C I�U_183
Signature Contracror's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge E Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Piumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposii �
Sewer & Water Permit Fee $ Other $
Gas Fireplace Perrnit Fee � TOTAL DUE $ �"'
This Appiicadon Becomes Your Building Pernut When Approved Paid , ReCei t o.
Date B
Buildin � Utlicial Date
Thu u to certify that the requcsr in the abuve appiicauon and accumpanying documents is in accordance with the City Zoning Ordinanee and may proceed ac requ�sted. This dexumrnt
whcro signed by the City Planner const�tutes a tempurary Certificare of Zoning mmpliance and allows canstruction tu commence. BeForr ixcupancy a C��rhficatt of Occupancy musi be
i.uucd.
Planning Director Date Specisl Conditions, if any
24 hour noticc for all inspections (9S2) 447-985(I, fax (9S2) 447-4245
4646 Dakota Street Frior Lake, MN 55372
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