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of PRt.� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
v AND UTILITY CONNECTION PERMIT
�1.4WESCli� I. White File
2. Pink City ( PERMIT NO. /6 3 SS'
i Yellow Applicant
e type or print and sign at bottom)
DRESS j ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNS /�
(Name) a O 1 6\ SO✓\ r ' �^
(Phone) .q5 a'�•t�'{�—� J
�O
(Address) ��
BUILDER
(Company Name) +n•C. c\ Area-e.( r� (Phone) ( St - -i C e,6
i (Contact Name) (Phone)
(Address) 19 Z U CD. -h8. °`C°` E.,...)•,e S'r •}�b LA\i-E. t 4`t\rQ S S iv?,
TYPE OF WORK 0 New Construction ['Deck OPorch ❑Re-Roofing ❑Re-Siding ❑Lower evel Finish ❑ fireplace
❑Addition ['Alteration ['Utility Connection 1Q (,`n WS ( l ,-CJX,S^firs
CODE: DI.R.C. ❑LB.C, ❑Misc. D��-eFn�
e of Construction: I II III IV V A B PROJECT COST/VALUE $ 131
panty Group: A B E F H I M R 5 U `''��
ision: 1 2 3 4 5 (excluding land)
I I hereby certify that I have fiimished 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 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 ca,revoke this per 4 r just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform need inspections.
, X , -b�(a9S234. le riiic..o
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # ( $
Permit Fee I $ SAC # $
Plan Check Fee $ I Water Meter Size 5/8"; 1"; $
State Surcharge j $ Pressure Reducer $
Penalty l $ 1 Sewer/Water Connection Fee # $
F i
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee ! $ Builder's Deposit $
Sewer&Water Permit Fee $ Other -- . ..$
Gas Fireplace Permit Fee $ TOTAL DUE $
This Application Becomes Your Building Permit When Approved Paid d"U (/ ) j Rec i.t No. 564i
Date q...,?/L.iG I B %T
. Building_Official Dateip
s 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
n 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
ecl
Planning Director Date Special Conditions,if any