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�� � PRI �'� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� \� � TEMPORARY CERTIFICATE OF ZOIVING COMPLIANCE
" � � `� AND UTILITY CONNECTION PERMIT
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l. White File pERMIT NO . �
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3. Yeliow Applicant
lease or ' and si at bottom
ADDRESS ZONING �o�«,�>
Iy 120 t-�� c��►e,r, �'�e�.� 1"��. , , � — �"r��r Lat�e, , rn''�
LEGAL DESCRIPTION (o�('icx use only)
LOT BLOCK ADDITION PID 2$ rZ`j��CY� .-p
O�VIVER
(Name) (Phone)
(Address)
BiJII.DER /
(Company Name) �I.Y'+r1GS t�ts�sn �'b0�-v. � L�atn�d �✓tC (phone) �5l_ - y�/� /G 7� ( ��
(Contact Name) :1 (Phone) 9" o19.P-�7/�'r ��.�
�aaa�s) s �y ''"` f.� ' �
TYPE OF �VORK ❑ New Consm�cdon p��cx ❑Pcmh -Roofing ❑Re-s� pr.owec �i Fia�sn ❑ Fae�,�ace
❑Addition pAiteration purility c�nection
CODE: QI.RC. DI.B.C. � Misc:
T�pe of Con.4troction I II III 1V V A B
Ocrapa�cy G�up: A B E F H I M R S U PROJECT COST/YALUE S
Dioisiion: 1 2 3 4 5 (ezcluding land)
I hereby eertify that I have fiunished information on this appliration whic� is to the best of my knowledge hue and rnnect. I also cenify thaz I am the owner or authorized a�t fo� the
above-mentioned property and thaY all wn truction will mnform to all existing state and local laws and will proceed in accordance with submitted plans. I am awaze that the building
official can revokc ' cau . Furthermore, I hereby agree that the city official or a designee may enter upon the praperry to perform needed inspections.
X --- _ . __ �{Ciqi0.�3 _ ____ __ _ _�!�-�2_ ___ --
_ _ -- - - --- _ ---- -- -- ---
SignaYeue C:ontractor's License No. Date
Permit Valuation ��� � Park Support Fee # $
Permit Fee $ �, � SAC # $
Pian Check Pee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ � � Pressure Reducer $
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Penalry $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ 8ailder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireptace Permit Fee $ TUTAL DUE $ .^�
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( 'i'hie An ati rnrs Yrn�r _�y�dar�4iwr�'r Whgn _ A paid Recei t N �
� � 2 Date B
I3ziiidine D te
This is to certify that the request in the almve applicaticm and accompanying documents is in accnrdance K�th the City Zoning Ordinance and may pmceed as requested. This document
when signed by the City Planner constitutes a tempurary Certificate of Zonu� compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
i�sued.
Plartnin� rJire�!nr Date gner;ai (`onfi. if sr.}•
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