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of R/o+P CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCEai.6 /6-
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.. AND UTILITY CONNECTION PERMIT
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I. White File /5 Z /a
4�NNESDlP 2. pink city PERMIT NO. Cy/{6
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
333 c5 '/is r-44
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
BUILDER
(Company Name -1:.!7' .4frtt'k '' . r'-4-s -- - (Phone) 6(-2-,. 02$2- ,e 2$g'
(Contact Name) e /1 4..l (Phone)
(Address) ,5-)51S-.:445C-971 7/1 4cm S'ctlr4 ie'/ -7-f---t <3'1,4/4,
G,
TYPE OF WORK ❑New Construction 'laeck ❑Porch Eke-Roofing Eke-Siding ['Lower Level Finish ❑Fireplace
['Addition EAlterat o ['Utility Connection
CODE: R.C. ❑I.B.C. 1:1Misc.
Type of onstrtiction: I II III IV V A B PROJECT COST/VALUE $
Occupancy Group: A B E F HI MR SU (excluding land)
Division: 1 2 3 4 5
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 revoke this permit for just cause Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X A4 --, ek .6�'6.35'16 y _ 67 _ /s-
Signature Contractor's License No. e0. l 9gop Date
Permit Valuation 4- Uoo. 06 Park Support Fee # $
Permit Fee $ U 3, — SAC # $
Plan Check Fee $ P63. •15+-- 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 I $ TOTAL DUE Lily,, k r .1., kr- $ t'T ) . 41.5—
This
,5This Application : co ,: Your Binding Permit When •..,pro•edi i Paid 7/,93 Rec pt No. )
Date ,0-_,<-f,is' By,//" _B .
Buildi'i ficial Da e
This is to certify that the request in the above application and accompanying docu,ents in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the C lar f r constitutes a temporary Certificate of Zoning c plia `e and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued /� �
/� f, / I
Planning 0 - _ I Date Special Conditions,if any
our notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372
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ADDRESS: ' W 1 a'/ �fr PID:
PERMIT TYPE: F}! "mo i� � DATE INSPECTED:
ADDITIONS/BASEMENT FINISHES/PORCHES •
FLOOR COVERINGS: Exterior Siding
Interior Wall covering
CEILING COVERINGS: • HEATING:'
BATHROOMS: FULL: 3/4: 1/2: OTHER PLUMBING FIXTURES:
BEDROOMS(addition or bsmt only) # CABINETRY:
FIREPLACES: # Type
%OF TOTAL BASEMENT AREA FINISHED: Bsmt Fair Bsmt Avg Bsmt Exclt
OUTBUILDINGS
BUILDING STYLE:
FLOOR:
WALLS:
ROOF:
HEATED:
, INSULATED:
FINISHED AREA:
OTHER/NOTES