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.4 >PR.o� CITY OF PRIOR LAKE BUILDING PERMIT,
Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
♦ofa►>esott' I. White File PERMIT NO.
2. Pink City J J� , 1 i1
3 Yellow ApplicantIJ V
type or print and sign at bottom)
DRESS �` ZONING(office use)
Tholie
a9 ,� .(4.s+ carr I-e„ 1 .)(
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
(Name)OWNE
R
t OrN 1A0 1 4C I(X (Phone) (0,10-53g -54- 11
(Address)
I BUILDER
(Company Name) n-e C.A.)Ol_` �hL{,e I`2.1'�'— . (Phone)
(Contact Name) �ty�yV — (as�(o U
y—� $$ (Phone)
(Address) i9 a b C( 4 , "C, U3. eg.oS C..v1 kA.0� IMrV 5 S 113
TYPE OF WORK 0 New Construction ❑Deck ❑Porch ORe-Roofing ORe-Siding ❑Lower Level Finish ❑ it lace
❑Addison DAlteration ❑Utility Connection lth Q L� S I 1 a d��
CODE: ❑I.R.C. ❑LB.C. ❑Misc.W/�Nv`� t �pY1 1��
Type of Corrstnrction: I H III IV V A B J Q
panty Group: A B E F H I M R S U PROJECT COST/VALUE $ (90� vJ(D
ision: 1 2 3 4 5 (excluding land)
I hereby 'fy that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authonzed agent for the
above• ned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. 1 am aware that the building
official ca oke this permit ' st cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform;fans tenons.X dO 130 4, 83v As
Signature Contractor's License No. D
V--
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
Penalty • $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee ## $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $
This Application Becomes Your Building Permit When Approvedd
Paid 7s"-,,,5 Receipt No.
Date '1Ji//.5 By y i
Building Official Date
illis to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
igned by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
Planning Director Date Special Conditions,if any