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� CITY OF PRIOR LA4N ti KECERTIFICATE BUILDING PERMITZONING
,
CONNECTION PERMIT Date Rec'd
easeease 6 / .
•e or,rint and si:, at bottom)
°m� 1. white File
2. Pink City PERMIT
774 I S 3.Yellow Applicant
NO. /
LEGALAllh
DESCR,>rTION(office use only) ZONING(office use
LOT r BLOCK I )
ADDITION 5 ,,�,� / s 4
(Name)R I i I /1/CZO
(Address) ff ✓t/ / (�'�i 1/L1 �� PID �.S 22g'00/_I1,
OI � ��L PS���► 1 II In � , j (Phone)C
BUILDER �t V �'w -✓ l/ 1'7) LOCK(
(Company Name) S-e l g 0
(Contact Name) 3� Z
(Address) ` f
V �j� p�� _•�,S (Phone) q /
VC Lc 2 —7. 2,60
TYPE OF yVO P Y. _ _ Si- . (Phone) �/
RR ❑New Construction �` � �� -
�Addition ODeck Porch /V �I
Alteration DUtig �Re-Roofing
CODE::e of OLR.C. OLB.C. tYConn c.,n ORe-siding
Construction:
OLOwer Level Finish
c�pancY Group: I II ❑Fireplace
abovVivision: A B E F IV V A B 0 Misc:
S ce?rify •ave 1 2 3 4 5 I M R S U PROJECT j�^
m .on.•pmpe furnished information COST/VALUE $ \/ -� O C
official .n rev; a this at allnon this apporario (excluding �/
X �� p •, jugd it .- cam confocrn to au ichsis to the best of my knowled land)
I hereby agree that nhg state and local laws and a true and correct I also certify
,�` ` ,� city official or a designee will proceed in accordancewith that I ne the
--�����-�_ gttee may enter upon the property[o subrrtitted pianrI am authorized a
perforin needed ins.e aware agent for the
Permit Valuati0�' ) that the building
coons.
Contractor's
Permit Fee License No.
Plan Check FeennaiPark Support Fee Date
11111111111111
Penal �' Water #
Penalty al/ r Meter
Size 5/8";1";
Plumbing Permit Fee •• �• - Pressure Reducer
Mechanical pefiga Sewer/Water
Permit FeeIIIIIIIIIIN Connection Fee #
Sewer&Water PIIIIIIIIII Water Tower Fee
Permit Fee Builder's De #
Gas Fireplace Permit Fee posit
Other
This Application Becomes Your Buil TOTAL DUE
g Pernut When Approved
Paid A1i
r ,ft, ei4
Buildin_Official Date
Recei.t No.
This is to cerci Date , B ����,_,
en signed ub,that the request in the above application
ed, y file City Planner constitutes a teand
temporary an accompanyingdoo P Iattce ian accordance with the Ci
Certificate of Zonin 40
allows cecowith
the to City
Zoning
Ordinance Qnd may proceed as requested.
Planning Director Before
occupancy,a Certificate This document
of Occupancy must be
24 hour notice for all ins Date
46no Dakota Strnspe tions(952)447-9550
E'.,Prior fax(95)747-4245 Special Conditions,if any
no
Lake,Minnesota 555372