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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
6 --UJ -0 2-
~i~i~e ~:~y I PERMIT NO. ():> _ 0-1'? A
Yellow Applicant . ~ I"> ~
ZONING (office use)
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La h f...-
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID 25-370-04-0- 0
OWNER
(Name)
S-kv L
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q ~'2-- - 22 lP '- I 4 I q
(Phone)
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(Address)
BUILDER
(Name)
(Contact Name)
(Address) 144bt
~ V111 ty CDvIc:,,\vt,t L~ t>V')
B i \ \ ~a v-tb n
~u.V ns, \illl<-...
(Phone) --.1~1- - 440 -- lif,O
(Phone)
r lL\1V .'-1
,
TYPE OF WORK
o New Construction
OPorch
ORe-Roofing
ORe-Siding
o Lower Level Finish
o Fireplace
OAddition
OAlteration
OUtility Connection
o Mise.
4 DDQ
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 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. J
X _3:1~ U1o/\~~ ^,,, I ~ 2b~lltl\ I D '-' }'}O DV
Signature ~ Contractor's License No. Date
Permit Valuation
Park Support Fee
SAC
#
#
$
$
$
$
$
$
$
$
$
Permit Fee
Plan Check Fee
$
$
$
$
$
$
$
$
Water Meter Size 5/8"; 1";
Pressure Reducer
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer/Water Connection Fee
Water Tower Fee
#
#
Builder's Deposit
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
Other
TOTAL DUE
I ~ifJL--n~?ff
~~ /{5jJ~--
es Your Building Permit When Approved
C,- 20 . CJ2-
Date
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 construclion 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 /7z,/o euK:/C oft Ie t-IJ.
TYPE OF WORK IJ~
USE OF BUILDING S /1'/ /2-
F
PERMIT NO. OZ-- 0'230 DATE ISSUED & -2 0- o~
BUILDER ~A/77bK- PHONE# 440-715V
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTOR DATE
J FOOTING I 6r. I 7/~/t!Jv
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
Il.....~ 'j I
I FINAL I /'A--, I 7()')-/tJ~
Call between 8:00 and 9:00 A.M. for all Inspections
FOR ALL INSPECTIONS (952) 447-9850