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,, CITY OF PRIOR LAKE BUII.,DING PERMIT, ��, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONIlVG COMPLIANCE -
" AND UTILITY CONNECTION PERMIT
�
f '�'N B S��
�: � �';�, PERNIIT NO.
� 3. Yellow Applicmt / � •• / ��
CdBC 0! iDd SL �lOL[Onl
ADDBESS � 2'ONlN(� (o�ce use)
� l77 1 �f0 `�'1 �
LEGAL DBSCBIPTiON (o�ce nsc oniy)
LOT BLOCK ADDITION pID
(Name) �'Yl �lIU�-2. � (Phone) 7� o� - �g�- � �- �0 0
cA�� 77 4�v � 7�1 � ��� /'l�t �U SS�7 �
Bvua4�
(�ompany Name) (Phone) �S� -� g �-(• 4 �
(Contact Name) (Phone)�S l—`�1$4— `�'- (o � fo
c�a�� 4`t � 11x�:�.� � rn�N�t
.
T�E OF WQB$ [] New Construction �Deck QPorch �Re Roofing Re-Siding �Lower Levd � 1
["�Additiqn �Altaatioa �Utiliry ConnecEioa
4'�1?$: �I;�..C. �i.�3.C. ❑ Mis�
T,y�e pi��ane I II IQ IV V A B J po
�ac7 �: A B B F H I M l�i S U P80JECT COST/VALUB S�+��`.
Divi�ioA: 1 2. 3 4 5 (e=ctodip,a Lad)'
I hadry ardfy that I have flimished mforma�tion on pplicatioa wLich is to the best of my ]mawkd� eroe and rnxrecG I iiso
abovamentio and tLat all constiucfloa ' oonfozm m all adating atate and locat laws and w�l ��Y th8t I am the owna or autho�:ed agent for du
official can oke ' 't f� just . F1uth , I h by a�ree that the P�d in acoazrdance with submi�oed plana. I am awm eLat Ihe bni�ing
° �'��� / � y � / Y �7���� a
� , `--� � 1 � �/ `. � �
S� Conuactor's Lianse No. Dau
Permit Valuation Pazk Support Fee # s
Perinit Fee S $AC # $
Plan Check Fee S WaLex Meter Size 5/8"; 1"; a
State Svrcharge $ Pressute Reducer $
Pemalty S Sewe�/"�Vater Conneccion Fee # a
Plui�bing Pezmit Fee S �t�r Towei � # �
Mech�nical Per�it Fee S Bui�ier's Deposit $
Sewer 8c Water �'ennit l�ee S Other s
Gas Fireplace Petmit ee $ TOTAL D'(J� $ �•,.�
TLis wpplic.don $eooma Yaur sm�a� re�it when Approved PBid ' N.
DBte $
Buil ' Official . Date
Thia is ro oertityr tliat the requeat in the above applic�tion and accompanying docuruents is in aeeoo�dana vrith the 6ty ZAning Ordinana and may proaed u reqaaoed. TLia dawmmt
when signed by the City PLnnet c�sdmtea a tmnpocary Catificate �' Zoning oomplianoe aad adovv: comstroction to connmmce. Befose occaPancY. a Cer138cate of Occapanry mnat be
issued.
P�eD° � � Spaaal Cmditio�s, �jf+nY
24 hoar notice �r nUU inspection� (9S3) 447-9850� fu (9S2) 447�245
�46 Dakota Strat 3.E., Prlor Lwky Minneeota SSi72