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Oo� pRlo�t. CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT /a / ,, l
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y�xNEsotr 1 white File PERMIT NO. 15; e.," '
2. pink city
,4 3 Yellow Applicant
111
type or print and sign at bottom)
RESS ZONING(office use)
11'330 zabe,woo d C -, S Z , 4010
LEGA//L DESCRIPTION(office use only)
LOT( BLOCK 3 ADDITION G L�.I` /U�`U 6//,9 0- / 1/11)ID 2S 2-9 T - o j /"4 o
OWNER
(Name) (i s �j i I-e_n (Phone) h� g. as I -50 y
(Address)
BUILDER
(Company Name)--?..Y1—t°UJ0.\ f , 1'•. (Phone)
laS t -ottoLi-k-i0 g (Phone)
Name) _ ( )
(Address) 19a(J CC).- d • .,Ci. W• 1ZUSe_c.r VIC1 1rY1v 55113
TYPE OF WORK 0 New Construction DDeck OPorch ORe-Roofing ORe-Siding DLowefr Level,QFinish D Fire ce
" `r3
DAddition DAlteration ❑Utility Connection R„ l�,� c,_,)y (� � 1'�Oll)s t ll�� "P�[`5
CODE: ❑LR.C. DI.B.C.
CODE:
0 Misc. Q�� nQ _._n._......__..__._...__.
pe of Construction: I II HI IV V A B ( p(�
panty Group: A B E F H I M R S U PROJECT COST/VALUE $
ion: 1 2 3 4 5 (excluding land)
I hereby cc ify 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-me toned 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 revoke this permit fokcause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspect ons.
ar ce2 _ /aoc. /s'
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # I $
Permit Fee $ `/ SAC # 1 $
I
,
Plan Check Fee $ "/ J Water Meter Size 5/8"; 1"; $
State Surcharge $ 1 1.11 Pressure Reducer $
Penalty $ ` Sewer/Water Connection Fee # $ i
Plumbing Permit Fee � $
Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit — $
Sewer&Water Permit Fee $ Other i $ CGas Fireplace Permit Fee $ TOTAL DUEI $ 2,5; /7`�'
This Application Becomes Your Building Permit When Approved Paid 1 --/-17-s'
' Remit NO.
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Date I . Mir 1 By
IF
Building Official Date
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 document0
I
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
d
Planning Director Date Special Conditions,if any