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o � pR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTTLITY CONNECTION PERMIT
U �j
��A'NBS��� I. Whi�e File
Z �;�, �;, PERMIT NO. �Z ,. ����`
3 Yellow Applicam
Please e or rint and si at bottom)
ADDRESS �� �� �() ZONING (otlFice use)
r��"..� � � � ��� � :/ P� ,�� �s , � � .�,�t
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
�WNER fT ��lJ� ���� �/-� F1 L '� (Phone) �/ / �^ / / � �
/
(Address) ��J"� ..� � �!� � �� � �> !' `p� �, �
BIJII..DER '"' L / ,�0 /� C �/' G�/L.S 7` � � , j �' �/ �"" S.3S� S �
(CompanyName) � �� G ��` / �� (Phone)�
(Contact Name) � l � � /�/� `��'�'�/ L�� � (Phone) 9'�"lr-� "�� � �
(Address) l � � i�` �� v � � �� �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Udlity Con ction
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III N V A B pROJECT COST/VALUE S�f'' ��
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certiCy that 1 have fumished information on this application which is to the best of my knuwledge true and coRect. 1 also certify [hat I am the owner or authonzed agent for the
above-men oned property and tha[ all cunstruction will conform to all existing state and local iaws and will proceed in accordance with submitted plans. I am aware that the buildmg
ufficial ca revoke this prrmi or jusc c s Furthermorc, I hereby agree that the city official or a designee may enter upon the property to perform necdcd inspcdions.
x ����� y�
ignature Conuactor's License No. Date
P it 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 a
Gas Fireplace Permit Fee $ TOTAL DUE $ 9 T,7
This Application Becomes Your Building Permit When Approved Paid Recei
Date ,1 B
Buildim� Ut7icial Date
This u to certify that the requcst in the abuve application and accumpanying documenu is in accordance with chc Ciry Zoning Ordinance and may promrd as rcqu��cced. Th�s ducurtx�nt
when signed by the City Planner cunsnmtts a remporary Certificate of Zoning complianee and ailows cunstrucHon to commence. Befute uccupanty, a C�y'nficate of Occupancy must be
issucd
Plenning Director Date Special Conditions, if any
24 hour noticc tor sll inspections (952) 447-985(i, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372