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o ?Rio CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
, ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE -:),/7, / '7_, x AND UTILITY CONNECTION PERMIT
rn I. white File PERMIT NO. /Z— 43
..�'NESOlt 2. Pink City
3 Yellow Applicant
(Please type or print and sign at bottom) ZONING (office use)
ADDRESS ? p
)(,(p u (uAis( ,3 ic /( �vG� si_ V rlor t' -A/ , A g- f 3 7 Z
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER \ (Phone) 5 ` S ° - �f3 5 3
(Name) Ji�S4t 5�19�xcn
(Address) / 4 6 33 a , , , , 4 ) , . , k. 4 v . c. , Sv P c,r LA 14,c evvi( S — S - j 7 z
BUILDER (Phone)
(Company Name)
(Phone)
(Contact Name)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ['Porch Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
['Addition ❑Alteration ❑Utility Conncrtto
❑ Misc.
CODE: I.R.C. ❑I.B.C.
Type of C nstruction: I II III IV V AB PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
above - tto dapropet have and rsh t all construction this ill conform to all existing state and loc laws and will proceed t in accordance with `st submitted the plan owner 1 am authorized warethat the building
official can r. oke th • •erm or Just cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X Contractor's License No. Date
Signature
Park Support Fee # $
-rmit Valuation ��" # $
Permit Fee $ 7 i :1 S SAC $
Plan Check Fee $ Water Meter Size 5/8 "; 1 ";
State Surcharge $
Pressure Reducer $
I C ". $
Penalty $ Sewer /Water Connection Fee #
$ Water Tower Fee # $
Plumbing Permit Fee $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other
Gas Fireplace Permit Fee $
TOTAL DUE $ -761:7-
Re pt No. &SW I
This A atio '� 1 Becomes Your Building Permit en Ap oved Paid
1 / '� - 7 l �- Date ,, (Z , t'Z- -` I By
A ,ifiill&■4 Buil - theta Date
This rs sito gned ecertify y the City in the above
constitutes a temporary Cerrtifc taccompanying f Zon ng compliance nd construction to commence. Ordinance fore and requested.
a C rtiicate ofOcct pancy must he
when signs by Y
issued.
Planning Director
Date Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372