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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
6- 22-02-
() 1- 112-9
1. White File
2 Pink City
3_ Yellow Applicant
PERMIT NO.OZ- 1030
3027
/13rl1 t.- ;1/11/
eOBMT
ZONING (office use)
~/
LEGAL DESCRIPTION (office use only)
LOT 21 BLOCK .3 ADDITION
7716 1'1// t-OS .s C/L/777
PID 2.5- .382 - () 75 - ()
(Phone)
~12.- -~ 70 -0~30
w
(Address)
BUILDER
(Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK
o Porch
ORe-Roofing
ORe-Siding
o New Construction
Deck
OLower Level Finish
o Fireplace
OAddition
o Alteration
o Misc.
PROJECT COST IV ALUE (excluding land) $
OUtility Connection
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 buil 'n 0 . can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
enter~property.to perfo ede e s
X
Contractor's License No.
Park Support Fee
SAC
#
#
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
$
$
$
$
$
$
$
$
TOTAL DUE
Water Meter Size 5/8"; I";
Pressure Reducer
City SAC and WAC
Water Tower Fee
Builder's Deposit
Other
#
#
Gas Fireplace Permit Fee
our Building Permit When Approved
8 .2.2~o<-
Date
~ 11L/02.,
Date
$
$
$
$
$
$
$
$
$ //5-2
4Z7(,~
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
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS 302r &bC\n ~
TYPE OF WORK ~C<=-
USE OF BUILDING 5'FD
PERMIT NO. (jZ-/036 DATE ISSUED B-'l.?
BUILDER '--1 ro 1J~'s b..",Jt.J C ) PHON E # {, (z.. (,70. c..G,J'O
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FOOTING I 7ftr. I J!l ~;, z.-.
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
r~ I I
I FINAL I ~ I '-( IV{ IlY3
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (952)" 447-9850
,
,