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o � pRt CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORA.RY CERTIFICATE OF ZONING COMPLIANCE
� AND UTILITY CONNECTION PERMIT �. Z 7 � 2'
� �
4�NNES�S� 1. Whi�e Pile
� �;�, � PERMIT NO. � � � `l�,Q
; Yellow Appiicam
Please or rint and si at bottom
ADDRESS ZONING (oft'ice use>
5 2 `� n VS �. � rt- �v� � �( �
LEGAL DESCRIPTION (of�'ice use only)
LOT BLOCK ADDITION PID
OWNER 1
(Name) � � �o � �' �l' (Phone)
(Address) � °t ��C.. OCS d��j � v�
BUII,DER T2 I f (�
(Company Name) lJ�l � I����/�,�� �1 t�GQ� Tl � (Phone)
tContactName) �L {Phone) � r2 � ��� • � �
(Addxess) � � p � '� (��; �,.�— !�
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch �e-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Aiteration ❑Utility Conne ion
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B PROJECT COSTNALUE S V� d �• Od
Occupancy Group: A B E F H I M R S U
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have (iimished information on this apptication which is to the best of my knowledge true and correct. [ also certffy that ( am the owner or authorized agent for the
above-mennoned propc�ty and th all c�ns uction wili conform to all existing state and local laws and will proceed in accordance with submittcd plans. [ am aware that the buildmg
uff'ici revoke this mlt for st cause urthermore. I hereby agree ihar the city o�cial or a designee may enter upon ihe property to pcnform nredrd nspecti ns.
! ° ���3��c�z �
Signature Contractor's License No. ate
Permit Valuation Park Suppor[ Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; t"; $
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 Firepiace Permit Fee $ TOTAL DUE $
Tluis Applicacion Becomes Your Buiiding Perntit When Approved Paid R ei t NO.
Date
Buiidine Ut3icial 01te
This rs to cercify that thc request in the above applicahon and accumpanying documents is in accordance with the Ciry ZAming Ordinantt and may procerd u requ��sttd. Thls document
when signed by the City Planner constrtutes a tempurary Certi6cate of Zoning compliance and allows construction ro commence. Befure ixcupancy, a Cert�ficate ��f Occupancy must be
issucd.
Planning D'arector Date Special Conditions, if any
24 hour no6cc for all inspections (952) 447-98g0, fax (452) 447-424i
4646 Dakota Street Prior I.ake, MN 55372