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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
6--u -0 2-
I, White File I PERMIT NO ~
2 Pink City . t)? ,,0-1 ~
3. Yellow Applicant G/ I~ _
ADDRESS ZONING (office use)
I' L\ D
La h f.,-
~E
{?,i"tv-
DtllL
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID 25-370-040- 0
OWNER
(Name)
S-\cYL
\/2-\0
gY1SSttt
~u- y bet IL
q ~'2.- - Z-"2. LP - I 4 I q
(Phone)
Lit h t,
Sf:
(Address)
BUILDER
(N ame)
(Contact Name)
(Address) 144bt>
'~V\.-n-(y ~~~G~ (:)Vl
B i \ \ t1a..v-tb n
~U-V VlS VI Il<-.-
(Phone) -.1~1- - 44D -. "lls0
(Phone)
to lL'\Iv'-/
I
TYPE OF WORK
o New Construction
OPorch
ORe-Roofing
ORe-Siding
DLower Level Finish
o Fireplace
DAddition
DAlteration
OUtiIity Connection
o Misc.
4 beo
PROJECT COST/VALUE (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_---.V1~ ~~~ 2b1-llt>\ID ~)~O D1/
Signature Contractor's License No. Date
Permit Valuation
Permit Fee
Park Support Fee
SAC
#
#
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Pem1it Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
Water Meter Size 5/8"; I";
Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
Other
#
#
TOTAL DUE
I ~;c~;mJ
~~ /{~~-
es Your Building Permit When Approved
(,,- ?O. CP-
Date
This is to certity 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, ifany
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 /7?/o euKYC oft Ie... t-IJ.
TYPE OF WORK 121.JfJ!:-
USE OF BUILDING S /1"/ /C-
PERMIT NO. OZ-~O'23(o I'DATEISSUED &-ZO-O?~
BUILDER ~N77~ PHONE# 44o-71sc.J
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
I FOOTING 'I!q-. I 7/~/~Z-
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I f.... .~ I) ,
../
I FINAL I /~; I 7()J-/tJ~
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (952) 447-9850