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oF PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
.. � AND UTILITY CONNECTION PERMIT '� � ' (L
U �
A►jNNE$��P I. White File
z � � PERMIT NO. �� - 7 �1 �
3 Yellow Applicant
Please e or rittt and si at bottom)
ADDRESS ZONING (o�f'ice use)
_�
`� S 15 �a r r ( �cw n� n re� I Y�r� ; � P r i o r Z c� K� M r�
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER �. Q �I �--U
(Name) � C�� � L � �.A l � °e (Phone) -/ J Z ' � �t � � � b ��
(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 ti n
CODE: ❑I.R.C. ❑I.B.C. � Misc.
Type of Construction: I II III IV V A B pROJECT COST/VALUE S
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby crrtify that 1 have fumished information on this application which is ro the best of my knowtcdge tnie and correct. I atsu certify that 1 am the owncr or authonzcd agcnt for thc
above- rd property and that a(1 construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
ufFic' can re ke this per i fo t ause. Furthe ore, I hereby agree that the c�ty officia( or a designee may enrer upon the property to perform necded mspections.
. � X � —Z—�Z
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 Permit When Approved Paid ei t NO.
Date
Buildim� Ufticiai Date
Th�s �s to certify that the requcst in the abuve applicahon and accompanying documents is in accordance with the Ciry Zoning Ordinantt and may proceeA as requcsted. Th�s ducument
when signed by the City Pfanner consututes a temporary Ce�tificate of Zoning compliance and allows consauction to commence. Before occupancy, a Cenificate uf Occupanty 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