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oF ptt� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �r�� �
U � AND UTILITY CONNECTION PERMIT 7'
�
�rNxeso'�r � wn��e File PERMIT NO . � Z �Q�
2 r��� r�
: Yellow Applicant
F rint and si at bottom)
__�:_: _ __ - � ZOI�IIl�TG (uffice use)
, � � �. �� `�-. �i�.� �T�
LEGAL DESCRIPTION (oflf'ice use only)
LOT BLOCK ADDITION PID
O a WNER ' r �/� ,� "� � ,; (Phone)
_�
(Address) � ! f��st� � � �
BUII,DER >���,,� �,� �
(Company Name) � /��Av � �'�' ���.rUf/� _ (Phone)
(Contact Name) ���c. � ��?l/►(� (Phone) 76 � � 7d D 7 �
(Address) t '� �'�i � �f/ C� � l
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-5iding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Udiity Connec ion
CODE: ❑I.R.C. ❑I.B.C. O Misc.
Type of Construdion: I II III IV V A B pROJECT COST/ VALITE $
Occupancy Group: A B E F H 1 M R S U
(excluding land)
Division: 1 2 3 4 5
! hcreby certify that [ have fiirnished infnrmation un this appiication which is to the best of my knowicdge true and cvrrect. t aiso cectify that I am the owncr or author�zcd agcnt for thc
above-ment�oned property and that a(i construction wili conform to all existing state and local iaws and will proceed in accordanee with submitted plans. I am aware that the buildmg
� ufficial can revoke this permit for jnst cause. Furtheimore, I hereby agree that the ciry official or a designee may enrer upon the property to perform needed mspections.
X
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 $ 7
Gas Fireplaee Permit Fee $ TOTAL DUE $
This Application Bernmes Your Building Perntit When Approved Paid Cei t NO.
Date
Buildins Ot�icial Date
This rs to certify that thc requrst in the above appiicatton and accumpanyin� documents is in accordance with the City ZAming Ordinance and may proceed as requcs[ed. This d�xument
when signed by the Ciry Planner constuutes a tempurary CertiBcate of Zoning comptiance and alluws conswction to commence. Before occupancy, a Ccruficate uf Occupancy must be
issucd-
Planning Director Date Special Conditions, if any
24 hour noticc for ali inspections (952) 447-985t1, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
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