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'PR CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
( � I \`■`;TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
u / t' AND UTILITY CONNECTION PERMIT
A'NESD
I. Pin hie
it PERMIT NO / /.. 056 2. el City / - J
3. Yellow Applicant i /.
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PIO
OWNER / e ��
(Name) �L 5 ��t z ,.. - - _ (Phone) ,9.-? -997 — /
(Address) 949 / 2 k? 4 AO"' L(+tC% ..61 i .17
( ,fr''' , 5%44 ,/ .u, 'GC. (Phone) 2 .3.s `y(e :ra
(Contact Name) A . e - i (Phone) 7G 3 — 3 S =- g<4.,..
(Address) /` "--- $ / „4,5;4. ,e/of... / a�i.►r/- / Airo,v 53
TYPE OF WORK ❑ New Construction ❑Deck DPorch Rootin ❑F_e- sidiag ❑ .awer Level Finish ❑ Fireplace
DAddition DAlteration ['Utility Connection
CODE: ❑I.R.C. ❑LB.C. ❑ Misr.
Type of Construction: I II III IV V A B
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $ �-S 2'x''
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above - mentioned pro. - that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can rev() . - • . for ju . s-. -. h- — .r -• agree that the city official or aa may enter upon the propesy to perform needed inspections.
S ' • . e Contractor's License No. Date
Permit Valua ion nark Support Feii # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/S"; 1"; $
State Surcharge S $ Pressure Reducer $
Penalty $ Sewer /Water Ce inection Fez # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ 1 Other $
Gas Fireplace Permit Fee $ ETOTAL DUE - - $
This Application Becomes Your Building Permit When Approved Paid 17 R e , No
j Date v - L CI
Building Official Date v 411"
This is to certify that the request in the above application and accompanying documents is in accordance with the Cicy Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions. if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., - Pr er Laks, M r riesota 55372