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o � PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE /,
AND UTILITY CONNECTION PERMIT w• �`� Z '
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���'NESO�� I. White File
Z �;�� �;, PERMIT NO.� Z, ��
3 Yellow Applicant
Please or rint and si at bottom)
ADDRESS ZONING (oFlFice use)
� 7 I l- �/'S A�� j� Pr � or l.� l�� /�l f�l 5��5 3%�
LEGAL DESCRIPTION (oflPice use only)
LOT BLOCK ADDITION PID
OWNER
(Name) �� � i �� (Phone)
(Address)
BUII.,DER �^ �� � � �^ �7 — �I�O
(Company Name)��i.5%� �Gu� L�lljl� Gt/? 5 (Phone) �
(Contact Name) ��'� �! Ol�G/� !'<` (Phone)
(Address) 3 7�S f S l�� / l��7�7 Qll� 5 /V
TYPE OF WORK ❑ New Conscruction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. �1 Misc. ��T 6������� �
l `
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 l have fumished information on this application which is to the best uf my knuwledge tnie and correct. 1 also certify that 1 am the owncr or author�zrd agent for thc
above-menuoned property and that all construction will conform ro all existing state and local laws and will proceed in accordance with submitted plans. I am awarc that the buildmg
ufficial can ev ke this per it fo caus Fmthermore, 1 hereby agree that the clty official or a designee may enter upon the property to prrform necded mspections.
I X ��Y (� � �� �
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 $ �---
i
This Application Becomes Your Building Permit When Approved Paid S R C 1 t NO.
Date B
BuiWine Ufticial Date
Th�s �s to certify that the requcst in the above applicaUOn and accompanying documents is in accordance with the City Zoning Ordinanee and may pruceed as rcqucsted. Th�s ducument
when signed by the City Planner consnrotes a tempurary Certificate of Zoning compliance and alluws construction to commence. Befure uccupancy, a Ceruficatc of Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
.:.,�
. . .- .
CustomerApprovalSignature: r+' '"—' .
CuslamerName: I�'1.�� � VVV �tj„��ip � �/�r ProJeclN:_
NOTE TO HOMEOWNER: Are there any special rules, regulations or contracts required tor our performance of ihe project with any relevant
association such as a condo or homeowner's associalian? iF so, you must make us aware of such requirements in order for us to proceed wilh your
projecL Please provide any such requirements to your production manager (see Key Contaci Sheet).
NOTES
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� Must be done with every full bath remodel and every job coniaining any of the following: doored whiripool, (loor, demoldion, sub-flaor repair, relocation
of plumbing or wiring,
� Use solid lines �o indicate ihe current location of items. Make sure to include measurements.
� Use dotted fines lo indicate the new location of items (ii ditferent from current). IF THIS IS NOT DONE WE WILL ASSUME THAT THE CURRENT
AND NEW LOCATION IS ONE IN THE SAME.
� Use shaded areas to indicale where repair is needed.