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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
�, � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ( C�
"� ---� `�' AND UTILITY CONNECTION PERMIT
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,. wn�te File pERMIT NO. ! Q �t3
2. Pink Ciry
3. Yellow Applicant
ease e or and si az bottom
ADDRESS • ZONING (off'ice nse)
�:� I'lp ��� o��. SE
LEGAL DESCRIPTION (of!'ice use only)
LOT BLOCK ADDITION pID
OWNER n � ^
(Name) Q_►�'YYJI.tn � (Phone) "1 -k� -�'�'�-4'� �� 01..
(aaaress� 1 �1 `l0 55 31 �,
BUII.,DER (���, n
(Company Name) \X iJ`�Qfl S l �'Ld')A GZ.. � �'1C. (Phone) �S14 - ( 3q �
(Contact Name) _ K,� M �Z.J-�,1�5 (Phone) �`�`��
cAaa��s) � al �i �em L�'. � �cJ� � �l 55 3� $
TYPE OF WORK ❑ New Consuuction �Deck ❑Porch ❑Re-Roofing Re-Siding []Lowcr Level Finish ❑ Fireplace
❑Addition �Aluradon ❑Utility Connecdon
CODE: �I.R.C. ❑I.B.C. �Misc: �
T`ype of Constnution: I II III N V A B
Occapancy Group: A B E F H I M R S U PROJECT COST/VALUE S � �C�
Division: 1 2 3 4 5 (���� �)
I hereby certify thaz I have fumished infotmation on this applicadon which is to the best of my ]mowledge true and cosrea. I also c�ertify that I am the owner or authoiiz� agmt for flu
above-meationed property and tt�at all consauccion will conform to all existing state and local laws and will proceed in accordance whh submitted pians. I am aware that the building
official can oke this for just cause. Fhtthermare, I hereby agee that the city official or a desigiee may mter upon the property to pedorm needed inspecdons.
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Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Srucharge $ Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanicat Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ �
This Apptication Becomes Yo�u Building Permit When Approved Paid lt i t NO. / �
Date � l �j , f B
Buildin Official Date
T'his is to certify that the requesc in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requesced. This documtnt
when sigied by the City Planner cons[itutes a temporazy CertiScate of Zoning compliana and allows rnnstruction to commence. Before occupancy, a Certificate of Ocwpancy mu� be
issued.
Planning Director Date Special Conditions, if mry
24 hour notice for all inspecHons (932) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lske, Minnesota SS372
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