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o � rR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ��!��+
.. � AND UTILITY CONNECTION PERMIT �
U �
��HN�SO�h I. Whi�e File PERMIT NO l� �
2. PinA City ` Y / �
3 Yellow Applitam
Please or rint and si at bottom
ADDRESS � �"";/� �.� ZONING (vttice use>
�'�?� � t� � �-� t-°' � �� .
LEGAL DESCRIPTION (oFfice use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
r
B p y � Cre.�r �'
'om an Na !G/' �1 � `� (Phone) �` � � �" ��
Nam �� � �G � Gr!!'J �Pho
ress a� o Z- � � � �o � C O�
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-S'rding ❑Lower Level Finish ❑ Firepiace
❑Addition ❑Aiteration ❑Utility Conne tion
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B
Occupancy Group: A B E F H I M R S U p���CT COSTNALLIE �
Division: 1 2 3 4 5
(excluding land)
1 h�reby certiry that I have fumished information on this appfication which is to the best �f my knuwlcdge true and correct. I atsu certify that I am the owner or authorized agcat for the
atwve-menaoned property and that a(1 construction wili conform ro ail existing state and tocal laws and wi11 proceed in accordance wich submitted pians. I am awarc that the buildmg
uflicial c ok � is per or ju ca ,gurthermore. I hereby agree that the city official or a designee may enter upon the properry to perform necded mspc iuns. _
x ~ '��� .8� �3��s�
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 Fiseplace Permit Fee $ TOTAL DUE $ �
This Application Becomes Your Building Perntit When Approved PSId e i t NO.
Date (,�, _ t L
Buildim� Otticial Date
T'his u to certiFy that the requcsc in che above appiicat�on and accumpanying ducuments is in accordance wich the City Znning Ordinance and may pnxeed as requ�sted. This dexvment
whcn signrd by the Ciry Planner amstitutrs a tempurary Certificate of Zoning compliance and aUuws canstruction tu commence. BeFore iKCUpancy a Ceraficate nf Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noficc for all inspecteons (9S2) 447-9R50, fax (952) 447-4245
4646 Dakota Sireet Prior Lake, MN 55372
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