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oF PR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE C� �� ��
AND UTILITY CONNECTION PERMIT �
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ytNNE50�� i. wn��e File pERMIT NO ppp
2. Pink City �� . //-� � �
3 Yellow Applicant C �..I
Plea or 'nt and si at bottom)
DDRESS L !� �� ' {��� t.� �� ; ZONING (ot�'ice use�
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LEGAL DESCRIPTION (office use only)
LOT � BLOCK ADDITION PID
OWNER
ame 'F • - hone) � ��r��1�—��'3�_
(Address) ° � � L�. ,�,� �
BUII,DER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK � New Construction ❑Deck ❑Porch Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Conne io �
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
t hcreby certify that I have fumished information un this application which is ro the best uf my knowicdge true and conecc I also certSfy that 1 am the vwner or authonud agent for thc
above-ment� ed property and that ail construction wi11 conform so all existing state and tocal laws and wiii proceed in accordance with submitted plans. I am aware that the buildmg
ufficia! can voke this permit for t cause rthermore, I hereby agree that the dty official or a designee may enter upon the properry to pcn�form necded inspection .
I � �I
ignature Connactor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Che�k Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanicai Permit Fee $ Builder's Deposit $
Sewer & Warer Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ �
.
Tluis Appiication Becomes Your Building Permit When Approved Paid - Rece" t No.
Date � - B
Buildin � CTtiicial Date
This �s to certify that the requcst in the above appiicanon and accompanying documents is in accordance wich the Ciry Zorting Ordinancc and may proeeed Ls rrqursted. This document
when signed by the Ciry Planner conshtutes a temporary Certiflcate uf Zoning compliance and altuws constructi�n to commence. Befure �xeupancy, a Ceruticate uf Occupancy must lx
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for aIl inspections (952) 447-9RSp, fax (952) 447-4245
4646 Dakota Sueet Prior I.a1ce, MN 55372
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