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oF PRt CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT �� 2 z �� Z�
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♦jNNESO�� I White File
2 �;�� �;, PERMIT NO. �� ¢G
3 Yellow Applicant
Please e or rint and si at bottom)
ADDRESS ZONING (otTice use)
�/ ��n� ('�i��� v` (
LEGAL DESCRIPTION (oflf'ice use only)
LOT BLOCK ADDITION PID
OWNER • L /�
(Name) - t� �y T (Phone) 7 S .Z — � � T ���
(Address)
BUII..DER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Conn tio
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV 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 certify that [ have fumished information on this application which is w the best of my knowlydge true and correct. 1 also certify that I am the uwner or author�zed agent for the
above-menuoned prope�ty and that all cunstruction will conform ro all existing state and local laws and will proceed in accordance with submittcd plans. 1 am aware that the buildmg
iX �cial can re�is permi� t f�;u=t caus�rthermor I here a ee that the ciry official or a designee may enrer upon the property to perForm necded inspecuons.
� D�`' ZZ.- � 2
Signature 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 Application Becomes Your Building Perntit When Approved Paid - Re e' t No. S
Date s; Z Z,�Z B
Buildine Ufticial Date
This rs to certify that thc requcst in the above applicat�on and accumpanying documents is in accordance with the Ciry Zoning Ordinancc and may procerd as requcsted. This documcm
when signed by the Ciry Planner consututcs a tempurary Certificate of Zoning compliancc and allows construction w commence. Before �KCUpancy, a Ccruficate of Occupancy must bc
issucd.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (9S2) 447-9R50, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372