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01 111r04, CITY OF PRIOR LAKE BUILDING PERMIT, Date Reed
TEMPORARY R CATE OF ZONING COMPLIANCE �/
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v.`; AND UTILITYCONNECTION PERMIT ° ' 2,6 . Jr
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(Please tymiaitsti *`:A,,art
ADDRESS i ZONING office uzc)
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LEGAL DESCRIPTION(office use only)
LOT BLOCK AD DITION PII?
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► ... �►. 1,54?— ` - ` .
(Address) 544 a - J
(Company Name)ae)_ BUILDER . v' ,- •• 5 (Phone) 6s-7- ?3f9-13788
(Contact Name) t. 0.1
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'4,1J (Ph : e) rL' 36.1- S`
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.Adds ,t J"_ 1„ , , " - $01
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TYPE OF WORK 0 New Construction Y4 I . OP" -ROQhng ORe-Siding OLower t evel Finish .0 Fireplace [
ClAddiri on teratien '1Jtitihry Connection
Type of " - inn: I ii 111 IV V AB2 2 t • 434
'RO COST/VALUE $ _ ._ �
Occupancy Group: A B E 17 11 I M R S U exclsiding I 1
L'ivisim: 1 2 3 # S
I tieirby comfy that thaw famished witomtaiion on Chis mtphoahoo which cs to the beg of my knr utcgc rue atffi whom I alts comfy that I am tho uzenel in aottutetti^d agont for the
dithieniftehtnahiad ptahatthaxed that ad tainalhaCtain - r coaftwento all existing attic and local laves and will proceed au accordance with mffireattod plana t am aware'that the butitheig
nficaal Can revoke this ., oe Fr._,..•es .1 h.-" gem that the my official or a destglw may enter upon the property to perform hooded tnspectuans,-
Stu,, Contractor's Laterisc No. Date
Pertnit Valuation \ p p - Park Support Fee } $ 1
Permit $ SAC 4 . $
Plan Check Water Meter Saxe 5/S'' i�
State Surcharge $ o Pressure Reducer., $
H Penalty $ 1 Sewer/Water Connection Pee # $
P3stmlaing Permit Fee $ Water Tower Fee U r $
Mechanical Permit Fee $ 1 . Builder's Deposit $
Sewer&Water Permit Fee $ Other i $
Gas Fireplace Permit Fee $ t i TOTAL DUE • ", , �12. S $ 5.8 ,�__.§
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Cao tw isa comfy etre mum tt to the above offitsation and accumparwrr duc . Is a am r!anrc with t e Cir/Zoom—t O M—tom and may prx,On,d a, rceltec Cued Thu document
whist signed& C 'Imo cr,gsatutes a eempura y Ceskif'rcate e a ZoningLa. i tanoe rid a!&twti motittitttunrt to c onmenee extort it iupance,a C tdfrcate<sf Occupancy mutt be
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24 histo notice for all inspections M21447,1350
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