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oF pRtp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
F ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT �'�` l Z
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���'NES��� 2 I'in �; Y PERMIT NO. /�. �'�
3 Yellow Applican� � L�
Please or rint and si at bottom)
ADDRESS ZONING (o��ce use)
�(�� a.�l �S � � �iJ .
LEGAL DESCRIPTION (ofi'ice use only)
LOT BLOCK ADDITION PID
OWNER �^ i � ,
(Name) � �l �.� �- (Phone)
(Address) c��'ML
BUII.,DER � �� �� 3 � �
(Company Name) �! '- �� G'�> C N� • (Phone)
(Contact Name) C�I �7�� (Phone) �� 2 - S�! 7 `'�sy�
(Address) 'Z . ,S uT"►� �-�'F �W L� •
TYPE OF W�RK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Udlity Con ectio
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Conshuction: I II III N V A B pROJECT COST/VALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby cert' ' that have fumished information �r this application which is to the best of my knowicdge true and correct. 1 also certify that I am the uwncr or authonzcd agent for the
above-men ned p perty a that cons conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
official ca revoke his per or 'e F nher ore, ereby agree that the city official or a designee may enter upon the prope[Ty ro prrform necded mspcctions.
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� �C �o'� ci?�o �LI�/L
Sign re Contractor's License No. Date
Pe 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 Approved Paid • Re ' t No.
Date B
.
Buildin � Utlicial Date
This �s to certify that the request in the above applicanon and accompanying documents is in accordance with the Ciry Zoning Ordinance and may proceeA as requcsted. This document
when signed by the Ciry Planner consntuus a tempurary Ceitificate of Zoning compliance and allows mnstruction tu commence. Before occupancy, a Ccrnticate of Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372