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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
5'- 6-02-
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I. White File
2. Pink City
3. Yellow Applicant
I PERMIT NO.CJZ-{J,/q 7 I
,
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PIDZC-- 33~-u2-.r. 0
OWNER c- h ~ .... J t 5
(Name) \AI, N1~p ,J..J
(Address) /bJ~F Vie 1"..- - .:"
(Phone) t1' 5:< :2;( t:3t' 8 /
5'F
BUILDER
(Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK
o New Construction
Deck
OPorch
OAddition
OUtility Connection
OLower Level Finish
o Mise,
ORe-Roofing
ORe-Siding
o Fireplace
OAlteration
PROJECT COST IV ALUE (excluding land) $
I hereby certifY that I have furnished information on this application which is to the best of my knowledge true and correct, I also <;l!i1il'y 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 operty to erform needed inspections.
x
,/U---_
Permit Valuation '3060,00
Permit Fee $ fr? (~
Plan Check Fee $ 5'-1. II
State Surcharge $ ,. c;o
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
5"-8-OZ
Date
Contractor's License No.
:;-/ &/0 .7....
, Date
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 $ /38- eh
Paid
Date
" /t
/3(:}_ ~
I ~;1t ,fUlPCf
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
SITE ADDRESS I~-:s~ ~JI'lir"'''I'c.. C.OtV-lL
TYPE OF WORK ~k v ,
USE OF BUILDING SF()
PERMIT NO. OZ-O'!:!1 DATE ISSUED 5-8-0<-
BUILDER 1..,^-\Jc..l- t:k.p~ PHONE #
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTOR I ,DATE
I FOOTING I a.1n ~/Uf/OL
I to
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
,- ir-rlrji I I
, FINAL I ~ I If-IS -01-
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (952) 447-9850