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oF PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ��` `/
� x AND UTILITY CONNECTION PERMIT
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'�jN 1. Whice File pERMIT NO ��
2. Pink City Y
3 Yellow Applicant �1
Ple or rint and si at bottom
ADDRESS Z�NING (office use)
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LEGAL DESCRIPTION (of�ice use only)
LOT BLOCK ADDITION PID
ame) L�I�VN 0 (Phone) (�Y� S G� �� o S�
(Address) YJ�� �il.�, ��-'
B , �,,��� ' 4 n J b [
ompanyNam ►�1'^ � ���1► Phone) Z� �`—�� p
ntact Na e) �N1.1� (Phone)
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TYPE OF WORK ❑ New Construction ❑Deck ❑Porch -Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Urility Conne tion
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 I have fumished inf tion on this application which is to the best of my knuwledge mie and corcect. I also certify that I am the owner ur author�zed agent for the
abuve-mennon properry and that all ons uction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
official can re this permit fo just us urthermore, I hereby agree that the c�ty official or a designee may enter upon the property ro perform necded ins •ctions.
X e � � Z���
Sign tu ntractor's Li o. ate
Pe it luation 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 Whrn Approved Paid Cei t NO.
Date ,, .
Buildim_ Ufticial D�te .
This �s to certify that the requcst in the abuve applicat�on and accumpanying documents is in accordance with thc Ciry Zoning Ordinance and may proceed as requcsted. This dixument
when signed by the City Pianner consnmtes a tempurary Certificate of Zoning compliance and allows construction to commence. Before oaupancy a Ce�vficate ��f Occupancy must be
issucd
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372