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Date Rec'd
reio CITY OF PRIOR LACATS OF ZONINGBUILDING PCOMP MANCE � /
of R TEMPORARY CERTI �� 7"
a E. 7 AND UTILITY CONNECTION PERMIT
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I. White ie
t y PERMIT NO. . / 7J
2. Pink Cl
�A'NES��P 3 Yellow Applicant
ZONING(office use)
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ase ,• or .rint and si: at bottom)
ADDRESS IN
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LEGAL DESCRIPTION(office,�se onl ,4�/ / ,5/�4, PID 'Oe?9-����
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LOT � BLOCK ADDITION
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OWNER (Phone)
(Name) NQ r� <
(Address) a • 0 Al
BUILDER 'M G 0 C c-'1/ .$ ri-G •® (Phone)
I (Company Name) I (Phone)
(Contact Name) /I
(Address) •i 1,
�' . ..... s p
e.. V
TYPE OF WORK 0 New Construction ❑Deck ❑
Porch /'e-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace
❑Addition ❑Alteration ❑Utility Connection
❑Misc.
I B.C. ,� OOG�
IDE: DI.R.C. ❑ I II III IV V A B PROJECT COST/VALUE $
e of Construction: A B E F HI MR SU (excluding land)
panty Group: 1 2 3 4 5
Division:
I hereby certifythat 1 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
ned - city agree l that the city official or a designee may enter upon the property to perform needed. I am aware
ntio an 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
above-me ,� /
official re c is permit kir lust ca,t' Furthermore,I hereby t/ /
,I/ ! Date
Contractor's License No.X A� . .� •�gnature
Park Support Fee #
111111111111111
Permit Valuation 11111111"111111�j� SAC #
1111111111111111
Permit Fee !��!� Water Meter Size 5/8", 1",
Plan Check Fee 1111111111111111
Pressure Reducer 11111.111111111111
Sewer/WaterrConnection Fee #
UINIIIIIIIIII
Penalty1111111W- #
Water Tower Fee
Plumbing Permit Fee Builder's Deposit
Mechanical Permit Fee Other
Sewer&Water Permit Fee 111111111111111111
TOTAL DUE
Gas Fireplace Permit Fee 111111111111111111
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This Application Becomes Your Building Permit When Approved J ... i Recei.t No. �
B
Date it
Building.Official
Date
Bance and allowsordaconstruction with
nit commence.O. Before and may
a e Certificate eq of ed. This must be
to cern that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. Thisdocument
s is certify
en signed by the City Planner constitutes a temporary Certificate of Zoning tom
issued.
Planning Director
Special Conditions,if any
Date24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372