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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" AND UTILITY CONNECTION PERMIT
r
f �'N a S��
i. wn�ro Fue
z. r� c� PERMIT NO. , 1— U�0 'y
3. Yeliow Apptieent
ease e or t and si at bottom
ADDRESS ZONINQr (o�a we)
I�l�q ���rds ���.� ��
LEGAL DESCRIPTION (o�E'ice use only)
LOT BLOCK ADDTTION PID
� OWNER ( �^/ /
(Name) �a� I 2Cc-/��l'�� (Phone) _ . ld ( � ��� �d ��-.
(Address) �� � <<�� `e c�C.� lV " "
( IJII.DER ) C � < o � (Phone) 9cJ Z �� - �� � v
Com an Name J
(Contact Name) � � (Phone) �J ZC' � � G "l �
(Address) ; L p -{- .
TYPE OF WORK ❑ New Construction ODeck �Porch �e-Roofing ❑Re-Siding �Lowa Level Finish
[]Addition QAlteration �Utility Conn on ❑ F ��
CODE: �I.R.C. �I.B.C. ❑ Misc:
Type of ConstrucNon I II III N V A B �
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE S�. �7, 1�,���,�
Diviaion: 1 2 3 4 5 (eacl laand) T
I haeby axtify that I have flirnished informaHon oa this applimdon which is to the best of my lmowledge we aad ooned. I also oerNj� fhatI am the owna br anehoeized agmt for d►e
above-mma d property aa that all conatruction will conform to all aristing state and local laws and wlll proaed in aocordance wlth wbmtmd plena. I am awsre that tlie building
offidai oke e. Furthexmore, I hueby ag[ee that the dty oHidal or a designee may enter upon the property to pafoim needed inepe don
X 2 01 �7`��'s� `.
Si�ature Contractor's License No. a�
Permit Valuation �� Pazk Support Fee # s
Permit Fee a c , ��" SAC # $
, �
Plan Check Fee $ Water Meter Size 5/8"; i' ; $
State Surcharge $ S' U(, Pressure Reducer � a
P�tS' S Sewer/Water Conaeccion Fee # s
Plumbing Permit Fee $ Water Tower Fee # �
Mechanical Permit Fee $ Builder's Deposit S
Sewer & Water Permit Fee $ Other s
Gas Fireplace Permit Fee $ TOTAL DUE $ '7cj! '� S
'17�a wppticatton Becomes 7tour Euilding Permit when wpprovea Paid G 1�-LC Reeei t No
Date - �j— I B 7{,�i
�� � - �1-( I
Bu�a� o� na�
Th1a is to artIty that the rcquest ia the above appllcacion aad acoompaayin6 pocuments is in accordance with the City ZoNag Ordiaance and maY Ptoceed ea requeaoed. This docnment
whea sigaed by the City Plaaaer constltutes a temPo*arY Cettiflcate of Zoniag compliance and apows conaWCtion to oommma. Befnre axupanq. a Catlflcam oP Oocupsncy mnst be
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P�°°°'°g � �Q Speciel Condidons, if mry
24 hour notice for all inapections (952) 447-9850, taz (952) 447-4245
. 4646 Dako4 Street S.E., Prior L,ake, Minnesota 53372