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F pig CITY OF PRIOR CI Rec'd LAKE BUILDING PERMIT, Date Rec d
o TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
ti x
AND UTILITY CONNECTION PERMIT 9_�
;��NESO 1.White File PERMIT NO.
3 Pink City
1S -l f '7
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
11/ 11-11-1 Shady Bw.GCh Troo � Pr(-or Let Se, AM 553702
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID -ittr0
OWNER --7
(Name) �� 0 F: I ; PPe I I i (Phone) 5/0)-` f /-/,c Li
-7
(Address)
BUILDER
(Company Name) L I R S C 0 n 5-fr(n C"b 0 fl LLC (Phone) G10-0?Cl 3-00z4
(Contact Name) [C' C- Zu C.1 6. k Phone
add „ e (Phone)
3190
(Address) S�f� t',V
TYPE OF WORK 0 New Construction ❑Deck DPorch NRe-Roofing ORe-Sidi
i ng ❑Lower Level Finish
DAddition (]Alteration ❑Utility Connecti n ❑Fireplace
CODE: DLR.C. DI.B.C. 0 Misc.
•
Type of Construction: I II HI IV V A B
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $
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
II above-mentioned property and 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 - ke th' . it for just cause. Furthermore,I hereby agree that the city official ora designee may enter upon the
Property to perform needed inspections.
Jx
�`"'� 6G- GGS.Uy 09/o8i 0i5
Signature Contractor's License No.
Date
Permit Valuation Park Support Fee #
$
Permit Fee $ SAC
Plan Check Fee $ Water Meter Size 5/8"; 1";
State Surcharge $ Pressure Reducer
$
Penalty $ Sewer/Water Connection Fee #
Plumbing Permit Fee $ Water Tower Fee
Mechanical Permit Fee $ Builder's Deposit
K $
Sewer&Water Permit Fee $ Other
$
Gas Fireplace Permit Fee S TOTAL DUE
$
This Application Becomes Your Building Permit When Approved
Paid 75--7 I Receipt No. i?...:71j
Date C -F4.-5 By
ill 1
Building Official Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City 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 Dimotor
Data inspeetio
24 hour Hence for alt ns(952)449- tp Sitasial " if any
4646 Dakota Strait Prior Laka,MN 5 372