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OF Plitt CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
,� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
��NNESo•�P I. White File
2. Pink City PERMIT NO..
�A—5-it
3 Yellow Applicant �l
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
I/ 0-1'.6 Pgizii A C1c' Ailu-) '
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNERS(Name) IE��t�f'I�� (Phone) Z /r - 0 •3 `-C
j"" (Address) { - 6 p k -,,,Q..Q CA— )\11/0
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑New Construction eck EPorch ['Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace
❑Addition ['Altera ton ❑Utility Connection
CODE: ❑I.B.C. 0 Misc.
Type of$11.R.C.
struction: I II III IV V A B PROJECT COST/VALUE $
Occupancy Group: A B E F H I M R SU (excluding land)
Division: 1 2 3 4 5 t
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above-mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can e ke this permit for just c Furthermore,I hereby
agree that the city official or a designee may enter upon the property to perform needed inspections.
Signature Contractor's License No. Date
__--_-
Permit Valuation y2 6_ / Park Support Fee # $
Permit Fee $
-.7.. 3C 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 TM M�/G,,
This • 4(= cat'9 Becomes Your Building P 't en Approved Paid k 7Z Receipt No.11[ 7 ) Z_
4.
Date l\ (L -- By1
ilding Offici, Date
This is to certify t t the -cuest in the above application and accompanying docum is is accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by ity I nner constitutes a temporary Certificate of Zoning co lianc and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued.
arming Director , ate Special Conditions,if any
24 hour notice for all insp tions(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372