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�������, CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
" � \; ti�, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
; ___��;i� AND UTILITY CONNECTION PERMIT
�
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,. ,��,� File pERMIT NO. ' F } � - 2 7
2. Rnk Cdy I� �.J�/ /
3. Yellow Applicant
PIC83C 07' � �3� 8C�101bD1tl
ADDRESS ZONING (o�e �)
�� t' S_f." S � r �-a•��e. V��.1
LEGAL DESCRIPTION (og'ice use only}
LOT BLOCK ADDITION PID
ow1vER n ���1� 6st-ZY8'- �6 �,3
(Name) Kex (Phone)
(Address) Qg s 1b(nl
BUII.DER
(Company Name) (Phone) 6S�" 3� —�jYl.S
(Contact Name) (Phone) ` �
(Address) N�/�
TYPE OF WORK ❑ New Construclion ❑Deck ❑Porch �Re-Roofing ❑Re-Siding �Lower Level Finish ❑ Fireplace
�Addition �Alteration �Utility Connection
CODE: []LR.C. C]I.B.C. ❑ Misc:
Tppe of Consuvction: I II III N V A B
Occvpany Graup: A B E F H I M R S U PROJECT COST/VALUE S �e�D �
Division: 1 2 3 4 5 (eucluding land)
I hereby catify that I have furnis infortnation on this application which is to the best of my knowledge true and coxrect. I also certify thaz I am ihe owner or authoriud agent for du
above-mentioned axid all construction will conform ro all existing state and local laws and will proceed in accordance with submiued plans. I arn aware that the building
ofTicial can rev it " t cause. Furthermore, I hereby agee that d�e ciry offuial ar a designee may enter upon the property Co perform needed inspections.
X 2R�6.� 0 96( <
Signature Contractor's License No. Daoe
Permit Valuaaon Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reduoer $
Penahy $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanicai Permit Fee $ Builder's Deposit S
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $
TMs ApplicaHon Bernmes Yo� Building Permit WLen App�oved Paid Recei N. Z
Date B - -
Buila' Official Date
This is to certif�+ that the request in the above application and accomPanymg documrnts is in accrndance with tlre Ciry Zoning Oidinance and may procaed as requested. This document
when signed by the Ciry Planna constiwbes a oempvrary Certifica� of Zoning compliance and allows consaucdon bo commence. Befom occupancy, a Certrf'x;ate of Occupancy must be
issued.
Planning Director Dste Special Condi6ona, if my
24 hour no�ce for aU inspectiona (952) 447-9850, faz (952) 447-4245
4646 Dai�ota Street S.E., Prior I.ake, M'innesota 53372