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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
7-/7 --()-z-..
.sC?74-
White File I PERMIT NO
Pink City . (l-J ~ () e1 e;
YeHow Applicant ~ CI '-
]
e.e.OSS/9,A/D,€A
..5TeEeT
LEGAL DESCRlPTION (office use only)
LOT 7 BLOCK 4-ADDITION
ZONING (office us c)
POSD
eafl/~l- ,(210
771 AODN. PID zS-3Z2-- 30-()
OWNER
(Name)
8~AlD ON
L/l1!?50A0
,
(Address)
(Phone) ~S2-22~- ~7?t/
BUILDER
(Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK
o New Construction
OLower Level Finish
o Misc.
Deck
OPorch
ORe-Roofing
ORe-Siding
o Fireplace
OAddition
OAlteration
OUtility Connection
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 building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
enter upon e p perty to perfo eeded inspections.
x
Permit Valuation 2
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
es Your Building Permit When Approved
7-1?-OC-
Date
Contractor's License No.
{- 11- cJ ~
Date
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
City SAC and WAC # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ //5.Z(o
I Paid
Date
/ j~)-i:: Z-
I ~;ce1'-.
17-5;/-0
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 Sf!?. ~~~.t4 5\f
TYPE OF WORK '!::la- k I c&, ~ 1"1- f
USE OF BUILDING S.rp
PERMIT NO. oz-oe7( DATEISSUED 7-t7-oL--
BUILDER 'il,awQ.,.. ~~~ PHONE #9~~~-'in,/
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
r FINAL
INSPECTOR
I FOOTING .If.e. {)OQ~ ~",./ ~
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I FRAMING &b.. D""kl""'(t J ~ 19- I 7J?5~ V
, ;/VY/ r
DATE
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (952) 447-9850
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