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oF PRj�� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE r ���
� AND UTILITY CONNECTION PERMIT �(/� l�
v �,
4 1�y N ��p't�' l. Whiie F��e PERMIT NO. ✓J
2. Pink City � 7 �
3 Yellnw Applicam
Piease or rint and si at bottom)
ADDRESS ZONII�TG (otTice use►
lyo3\ \�,�Q�f�. � �
LEGAL DESCRIl'TION (oEFice use only)
LOT BLOCK ADDITION PID
OWNER p
(Name) � � 4,�� � O�S (Phone) �( � • �- � � ` �' 1 2 0
(Address) � p 3 � r �C'a►,,�� �b✓ ��-2
BUII,DER
(Company Name) ��t�t �1���5. �.�-� (Phone) Q S2 ' S` � - ,�6"�3
(Contact Name) b ��-���� ��t..S�-`� (Phone)
(Address) � �y2 �-g �L V i � l,� 9 r . C � �J' W�. '3 �
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch e-Roofing ❑Re-Siding ❑Lower I,evel Finish ❑ Firepiace
❑Addition DAlteration ❑Uulity Connection
CODE: ❑I.R.C. �I.B.C. • I� Misc.
Type of Construction: I II III IV V A B PROJECT COST/VALUE � �.� � 0
Occupancy Group: A B E F H I M R S U
(exciuding land)
D'svision: 1 Z 3 4 5
I hc7eby certify that I have fumished mformation on this appiication which is to the best of my knuwledge true and correct I aiso certi(y that I am the owner or authi�nzed agent for the
above-mennoned property and that all construetion wiA conform to all existing state and local laws and wiil proceed in accordancr with submitted plans. I am awarc that the buildmg
ufficial can revo t perm' �usc cause Funhermore. 1 heteby agree that the ciry official or a designee may enter upon the property ro perform needed mspectiuns.
x !��� 'I�C �,3 b o 3 a �.1- �(� �Zoi z
Signamre 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 Fireplace Permit Fee $ TOTAL DUE $'� '7
This Appiication Becomes Your Building Permit Whrn Approved Paid Recei t NO.
J �� /� Date �— (� B
l
Buildine Uiiicial Date
Th�s rs to certify that thc requcst in thr abuve applicahon and accumpanying documents is in accordance with the City Zoning Ordinance and may proceed ati requcsted. 'fhis dexument
when signrd by the Ciry Planner cunstrtutes a tempurary Certificate �f Zoning complianee and aAows cansmiction to commrnce. Before cmcupancy, a Cerhticare nP Occupancy must bc
issucd.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (9S2) 447-9850, fax (952) 447-4245
464b Dakota Street Prior Lake, MN 55372