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o � PR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE p���/�
U � AND UTILITY CONNECTION PERMIT �
y�HHeso'�� I. Whi�e F,�e PERMIT NO.�. `—��
?. Pink City
3 Yellow Applitant
Piease or rim and si at bottom
ADDRESS ZONING corr,�� use>
1'�%s� L�r�V
LEGAL DESCRIPTION (oftice use only)
LOT BLOCK ADDITION PID
OWNER ( �' � - � Z'�] I
(Name) �''�- � S�.- (Phone) �'�,�- �
<
(Address) � �
BUII.DER (' c � G ,�_
(Company Name) �"� � � (Phone) �(' � � � - 1 �CJ� .
(Contact Name) (Phone)
(Address) � 1�, - � U .�-. ,s � ,
TYPE OF WORK � New Construction ❑Deck ❑Porch e-Roo6ng ❑Re•Siding ❑Lower Level Finish ❑ Fireplace
❑Addidon ❑Alteration ❑Udlity Conn tio
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 pROJECT COST/VALUE S
Division: 1 2 3 4 5
(excluding land)
I hereby crrtify that [ have furnished information on this application which is to [he best of my knowicdge crue and correct. I also certify tha[ I am the owner or authonzed agrat for the
above-mentioned property and that all construction will conform to atI existing state and local laws and will proceed in aceordance with submitted plans. I am awaze that the buildmg
utl'icial can revoke rt just cause. Furth e, I hereby agree that the c�ry officiai or a designee may enrer upon the property to pertorm necded mspections.
X __���--- „�. , _�Y_le ( 9 -'��- � z'
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 $
Penaity $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOT.AL DUE $
This Application Becomes Your Building Permit When Approved Paid ReC t NO.
Date • /Z B
Buildim� C)iticiai Date
Tfis u to certity ihat the requcst in the above appiicauon and accumpanying documents is in aecordance with the City Z,�ming Ordinance and may proceed ac requ�sted. This de�cument
when signed by the City PLtnner constautes a tempurary Certi6cate uf Zoning compiiance and aAuws canstruction to commrnce. Befure occupancy, a Certificate of Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) d47-9RS(1, fax �952) 447-4245
4646 Dakota Street Prior Lake, MN 55372