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D
o F pRt CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE il _ ��,� Z
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AND UTILITY CONNECTION PERMIT �
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��A'NES��� � Wh,�e File pERMIT NO.
2. Pink City 1Z �
3 Yellow Applican� �
Please e or rint and si at bottom)
ADDRESS ZONING (oFlFice use)
' � � .�� , �'
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER �
(Name) G°� i✓ �O' (Phone) �� �' -��c��
(Address) f `��6 �61 � �s�- � .li✓ -- �
BUII.,DER � �
(Company Name) �'� � � �y .r (Phone) /e /��-��1— �
(Contact Name) (Phone)
(Address) L�� . /j� � ,ci �s r �y .
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Conn cti
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B pROJECT COST/VALLTE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify t ave mished i xmation un this appl' ion which is to the best uf my knowledge n'ue and coirect. 1 also certify that I am the owner oc authunzed agent for the
above-men d property nd th constructio rm to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buiidmg
I official revoke this mit t cause F , hereby agree that the c�ty official or a designee may enter upon the property ro perform needed mspecuons.
X �� �?� �'�`/ � l � `--�
Signamre Contractor's License No. Date
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 Apptication Becomes Your Buitding Permit When Approved Paid ' R t t NO.
Date ! B
Buildim� Utlicial D�[e
This �s to certify that thc requcst in the abwe applicauon and accompanying documents is in accordance with the Ciry Zoning Ordinantt and may proceeA as rcqucsted. Th�s ducument
when signed by the Ciry Planner conshrotes a temporary CertiFicate of Zoning compliance and allows construction ro commence. Before occupancy, a Ceruficate uf Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspcctions (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake MN 55372