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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
], z5,05
1 White
Pink
Yellm...,
File
City
Applicant
I PERMIT NO. Os: 07/ z+
(Please
ADDRESS
ZONING (office use)
/4/20
j-IJ9/fS LArcs ~/I~-e:
LEGAL DESCRIPTION (office use only)
LOT 1-BLOCK
I ADDITION
:l/ILD5
PID2S-:
OWNER
(N ame)
"V\
(Phone)
q<;:?-- 0-33- :;)7[fr.~
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK 0 New Construction
OAddition OAltera 0
Deck OPorch ORe-Roofing
OUtility ConnectIon
ORe-Siding
OLower Level Fimsh
o Fircpl,lCe
CODE: !,R,C, DI.B.C. o Mise.
Type of onstnlction: I II III IV V A B PROJECT COST/VALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: \ I 2 3 4 5
I hereby certity that I have furmshed mf"rmation on thIS applicatIOn which IS to the best of my knowledge t Ie and correct. I also certify that I am the owner or authorIzed agent flll the
above-mentIOned property and that all Cllnstructlon will eonf,)rm to all eXlstmg state and local laws and wi -occed 10 accordance with submItted plans I am aware that the buildmg
~rlCial c"N~e 2) pelmIt lor ust cause~ FUlthelm~helebY ::.e that the City offiCial or a deSignee may enter upon e plOpeny to pel form ne~pe5:~ _ 0)
Signature Contractor's License No 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 $ J47,II
Permit Valuation .00
Permit Fee $ ,2S
Plan Check Fee $ 3"
,
State Surcharge $ i. So
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
~.~
I l3uildllll! Oftlcial
Paid
Date
~4-7.-I(
.2J,Or-
1~2f
#b:D
7/2..-5' /os-
t Date
ThIS IS to certIfy thaI the request 10 the abuve applIcatlun and accompanymg documents is m accordance with the City Zonmg Ordinance and may proceed as requested TIllS document
when signed by the City Planner constitutes a temporal)' Certiticate of Zonmg compliance and allows construction to commence. Bcfllrc occupancy, a Certificate l)f Occupancy must be
isslled
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
COUGAR PATH
CERTIFIC"ATE OF SURVEY
C:TYOFJ'~OUiDDIGAN CUSTOM HOMES
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"""AF?ROVED'
PlANN!NG DEPT
Scale: 1"= 30'
Page 2 of 2
Jlfni~~mit2fgt.
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS /4/20 /-trlf/5 ~/e,e; (!,I~
.
TYPE OF WORK 0 eclC
USE OF BUILDING IZEf /-I/;?--
PERMIT NO. () S. 07/2.... DATE ISSUED 7 zs. O~
BUILDER ~O/J PHONE # Z3..? 2 74-0
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
~
, FOOTING r, I 2, ~ <=t ---d~ ' I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
~fP-""'- itJJ Ca:FOec 1:jf:4... 8ol'vW.<' 2 we I PIS 8-/b . aN
I FINAL
DATE
FOR ALL INSPECTIONS (952) 447-9850