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pCITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
(ci.
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
Ill AND UTILITY CONNECTION PERMIT
'1NNESet' I. White File PERMIT NO.
2. Pink City ��
e 3 Yellow Applicant
Ili
type or print and sign at bottom)
KESS ZONING colli se)
1 153 31 r\, Oa Cs Tm066 S L 1
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
(Name)
��` !•, -4. k 0V\ (Q p� • 143Z- -(/9 y
T� (Phone)
(Address) ��
BUILDER
(Company Name) h CWc..\ $v 'A118f,C'S-e.N (Phone) toS I -a icy-L(Q tE3
(Contact Name) (Phone)
(Address) t i Z O CO. fid. ''C" Lie S} •)' e vi\1-E ` \`i1 N S S II-2,
TYPE OF WORK 0 New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding
❑Addition ❑Alteration ['Utility Connection T _^ g ❑Lower Level Finish ❑Fireplace
"64'\a C¢. I rd Ow Lk d ocl s C..11,r ..D
CODE: t
QLR.C. ❑LB.C• E-Misc.•P}76S rn 6� 1 Type of of Construction: I II HI IV V A B PROJECT COST/VALUE $ a as 1 GO
panty Group: ABE F H I MR SU I
sion: 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[me and correct. I also certify that I am the owner or authorized agent for the
above-men oned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. 1 am aware that the building
official c revoke this permit f•t cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed ins nous.
x lb. ' s on-`7 LSC_ (49S.2'5'3- 9(.0
_
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # l $
Permit Fee $
� SAC # 1 $
Plan Check Fee $ ^Water Meter Size 5/8"; 1"; $
State Surcharge $ I Pressure Reducer $
Penalty $ I Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit — $ -
Sewer&Water Permit Fee $ Other ±$
Gas Fireplace Permit Fee $ I TOTAL DUE $
This Application Becomes Your Building Permit When Approved Paid 104. 00 ! tipt No. —1 °—c
Date 'Z , c-�.Ito ! -
Building Official Date
I
T is 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
igned by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
1 Planning Director Date Special Conditions,if any