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,, CI7'Y OF PRIOR LAKE BUII.DING PERNIIT, ��• Date Rec'd
� � TEMPORARY CERTII�'ICATE OF ZONING COMPLIANCE �
" AND UTILITY CONNECTION PERMIT
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r NNas°�
i. wn;n r���
x r;� a PERNIIT NO. �� -/ �
s. Yd�oW n�u�s
ease or and s at bouom —
ADDBESS ZONIl�T(� (os« use)
'?2� �d � o -v l - � ,
LEGAL DESC'RIPTTON (off'ice use only)
LOT BLOCK ADDTITON pID
(N� � � l ��.� �=�%C/L.�,LCJ (Phone) 5 �a `� � a - ��'-I' /
cAaa��s� �� " � " ,��. ' o�!-,�°� YhiV 5�
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(Company Name) � (Phone) � �- � g `"� - a�e � �
(Contact Name) (Phone)1� S � - � g �- �--�0 4 �O
(Address) �� �7'} Il� �� l
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' TYPE OF WOB$ p rrew consaucnon pDeck pPorch ❑Re-Roofing -sidins qLower L,evel F� A �L�
�Ad�iition �Alteration []UUlity Connection
CODF.,: [�LB.C. []I.B.C. ❑ Misc:
T7� P���on: I II III IV V A B �-- s �� 1 a
Occa�iqcy Groupe A B E F H I M$ S U P$OJECT COST/VALUB ��e , wO •
D i� i s i o n: 1 2 3 4 S (� �)'
I haeby artity I Lave fliroished infoimation on ' appHcation wlrich is co the beat of my ]mowkdge true and coirect. I also artity that I am the owner az suthorized agent for the
above-mena d and that all oansoiu ' conform to all aristing stau and local laws and w71 procced in acoordance witl► submitted plans. I am awatt that ffie bnilding
official can oke tLis 't for just ca . ore Laeby agree tLat the city offiaal or a may eater up� the
�V � �CJ l 7 � � to perfoim na � �j � . / �
% C� �
Signa e Coptractor's License No. Datc
Permit Valuati Park Support Fee # $
Pet'tnit Fee $ SAC # a
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer/Water �onnecCion �'ee # $
Plumbing Permit Fee $ W�ier Tqwer ee # $
Mechanical Permit Fee S Builder's Deposit $
Sewer 8c Water �'ermit Fee S pther $
Gas Fireplace Pe=mit ee $ TOTAL DUE $ 7
• T�°'''���OII �O�' YO��� p� �'� w�o� Paid Recei t N
Date / �. $
Buil ' Official . Date
'I'hiss !s w oertify ehar the reyuesc in rne abovo eppacaaon .na a«�ompanying aocuments is in a«�raaace wim me eiry zoning orainana ana ma
Y P� es I�Qnested. 17�ia document
when signed by the City Planna comsddues a temporary CemScate of Zoning compliaace and allows cronstructlon to commence. Before occu
� �ncp. a CatiScate of Occapancy mnst be
Planning Director Date Speciel Coaditi�0. iYeuy
24 hour aotice for all inspcctions (952) 447-985q fu (952) 447-4245
�646 Dakots 3treet S.E., Prtor Lskq Minnesota 55372