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oF PRtp� CITY OF PRI4R LAKE BUILDING PERMIT, Date Rec'd
,� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
� � AND UTILITY CONNECTION PERMIT
U �
a��'NESO�h I. white File
Z �,�, c�, PERMIT NO. ( Z, . � Z 11
; Yellow Applicam
Please or rint and si at bottom)
ADDRESS ZONING (ofcice use>
,:, �,- ? �"� l�� � .� �e. :
LEGAL DESCRIPTION (oflf'ice use only)
LOT BLOCK ADDITION PID
OWNER r '
(Name) {� ^ ���i4•u.� Qvv (Phone)
(Address)
BUII,DER /�
(Company Name) ���vs�. ��f--- �.�J�.J`U-iK.�.�_�L/ (Phone) �o � � °�.�� �YJ� ?
(Contact Name} ,�..�.rr�. (Phone)
(Address) � �j� ct,.� o .� ��-.
TYPE OF WORK ❑ New Construction eck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Levei Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: I.R.C. []I.B.C. ❑ Misc. ���� �r�"1 �S
Type of �nstiuction: I II III IV V A B PROJECT COST/VA,LITE $ 7}� •�O
Occupancy Group: A B E F Ii I M R S U
Division: 1 2 3 4 5 (excluding land)
i hcreby certiFy thac I have fumished information un this application which is to the besi of my knowicdge rrue and conect. f also certify that I am the uwncr or authonzcd agcnt for thc
above-mennoned pr y7ty and t onstruction will conform to all existing state and local laws and will proceed in accordance with submitud plans. i am awaze that the buildmg
ufficial can revo 'permit f c tse Furthermore, I hereby agree that the city o�cial or a designee may enter upon the property ro perform necded mspcctions.
X ��— C�k ZC� �7_c� �
Signature Contractor's License No. Date
Permit Valuation �� � Park Support Fee # $
Permit Fee $ Z �r � SAC # $
Plan Check Fee $ i�p — Warer Meter Size 5/8"; 1"; $
State Surcharge $ , S o Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Piumbing Perrnit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ � ���s
This piic tion ec s Your BuiCding Pemtit rn Ap oved Paid Q- . � ReCei t No. 3
� Date B
, fio 26 (Z�
Be DaCe
Tfiis �s to certify that the r qucst n the above applicatian and accumpanymg documents is en accordance with rhe City Zoning Ordinance and may p�rocred ac requested. This document
when sign � by the Ci tanne cnnstuute�t temporary Certificare of Zoning mpliane and aUows constniction tu commence. Befure uccupancy, a Cert�ficatr nf Occapancy must be
issucd
.� O 2�, C Z.
Planning ate Special Conditions, if any
24 hour noticc for aIi inspections (9S2) 447-9850, fax (952) a47-4245
4646 Daicota Street Prior I.ake, MN 55372
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