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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
5389
/l/170t&;vooO
Date Rec' d
5 -' f ~ DZ-
I, White File
2. Pink City
3. Yellow Applicant
PERMIT NOt:>z. _ 1)"8
OelV6 N6
ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT 4BLOCK 2- ADDITION '77H .,&100/1/. 7V N. S/-ft:Itz..& tJA--/GS
PID z5 -3+0 -012-0
OWNER
(Name)
(Phone)
J(o -3 .- / 7r "j
(Address)
O,.qVlj;J /JUVl Y
SOrJ n 6'
BUILDER
(Name)
(Contact Name)
(Address)
,~!I
(Phone)
(Phone)
TYPE OF WORK
o New Construction
OPorch
o Lower Level Finish
o Mise.
ORe-Roofing
ORe-Siding
o Fireplace
OAddition
OAlteration
OUtility Connection
PROJECT COST IV ALUE (excluding land) $
I hereby certiry that I have furnished information on this application which is to the best of my knowledge true and correct. I also certiry 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 pr to pe orm needed inspections.
x
Permit Valuation
3000.....
~~.'2<;
54.11
I. ::; 0
Permit Fee
$
$
$
$
$
$
$
$
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
~ p'rmit;~
I
Contractor's License No.
.tj /..;.2 1 h .2-
( D!te
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ \ 32>. g<;o
Paid
Date
138. e (p
5 - 2- - G'-z.--
I ReCei~4(7(q7
By "J
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director
Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
PRIOR LAKE
INSPECTION
RECORD
S~~~ AM.Q~~ U(l
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS
TYPE OF WORK 0 8:-~ I
USE OF BUILDING rz-.t;s A-/fL / I
PERMIT NO. 07-, 4~e DATE ISSUED t:;/, jC>"L
BUILDER i)AVlv A'-"'1 PHONE#4o~_(7'3
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
IN~ DATE
I FOOTING , /5/'3/0 ~
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
~ I I
I FINAL I L//;Y/ I! () - J..' - U 2-
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (952) 447-9850
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CERTIFICATE OF SURVEY
For:
Sup~rior Constroction"l J..i'l~r::
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