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oF PR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
�, �. TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT �� � �` �
v �,
4��'NESO�� �. Wh,�e File PERMIT NO. �L •� Z
2 Pink City
3 Yeliow Applicam
Please or rint and si n at bottom)
ADDRESS ,"� ll. � /`%,( �✓� ZONING tot� use)
��o ��'�' VV fJ �it/
LEGAL DESCRIPTION (of£ice use only)
LOT BLOCK ADDITION PID
OWNER �_
(Name) -�� (Phone) �S�' .Z9 �— .sp3a
(Address) �// �
BUII,DER /+ �
(Company Name) O` i�- (Phone) ���-� �!�''���7
(Contact Name) �c� (Phone) �/�o? � 7 �DS,,��
(Address) � ,� � „�
TYPE OF W(JRK ❑ New Construction ❑Deck ❑Porch �oofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Con ection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
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 i h e fumished infnrmation on this application which is to the best of my knowlcdge true and correcc. f also cettify tha[ I am the owner or authonzcd agent for thc
alwvamennoned pr •rty an that a construction wiii conform ro all existi�g state and local laws and wiil proceed in accordance with submitted plans. I am aware that the buiidmg
ufficial can rev is per fo ause urthermore, I hereby agree that the city official or a designee may enrer upon the property to perform needed mspections.
x /'��' U!'J 5�,� S� � —/�—�4'/�—
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; i"; �
State Surcharge $ Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Piumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ t Z i
This Apptication Bernmes Your Building Perniit When Approved Paid Re i t NO.
Date ' ( B
k3uilJinc Utiicint D�te
Thu �s to certiFy that thr requcst in the above applicahon and accompanying documents is in accordance with the Ciry ZA>nin� Ordinance and may proceed ac requcs[ed. This dixvment
when signed by the Ciry Planner coa5ututes a tempurary Certifieate of Zoning compliance and alluws conshvetinn to commence. Befure uceupancy, a Cerhticau of Occupancy must be
issurd.
Planning Director Date Special Condidons, if any
24 hour noticc for alf inspections (9S2} 447-9850, fax (952) 447-424i
4646 Dakota Sueet Prior Lake, MN 55372