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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
('-_M__:"~
17::~ fg~.I,^,~", I
Date Rec'd
/1.z,Z 04-
1. White File I PERM T
2. Pink City I NO.
) Yellow Applicant ,
04-- . II ~d
ZONING (office IlK)
K4-
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID Z$le7, u3o, /
OWNER
(Name) 6C&7T {DUA;Tj fj~UfJ1JJ5 q",J
(Address) 3.2 <Sr-
BUILDER ~
(Company Name) r.> J) u7&I'I"a.'"T~J
(Contact Name) arn-^ '1<~t'...<,
(Address)
EN7e~/tC!C:-::-'
RecJf" vie P f1.1t'>.G'T /1r}t.~, .1} (Phone) ( '152) - 41>2. - 7~' 22...
"She.
(phone) I-~-L/'O gy~,(
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch o Re.Roofing ORe-Siding OLower Level FinIsh 0 Fireplace
OAddition !9Alteration DUtility Connection eg:Misc,
CODE: OI.R.C. OJ.B.C.
Type of ConstIUction:
Occupancy Group: A B
Division:
I
E
n
F
1
ill IV V A
HIM R
2 3 4 5
B
S U
PROJECT COST IV ALUE $
(excluding land)
/ /, 86D ~-'--
I hereby certify that I have furnished mformation on Ihis application whicb is to tbe best of my knowledge true and correct, I also certify that I am tbe owner or autbonzed agent for the
above-ment d propeny and that aU construction will conform to all existing state and local laws and will proceed in accordance with submitted plans, I am aware that the buildinl
official c re ke this permit f0f~~se, Furthermore, I hereby alll'ee that the City official or a designee may enter upon the property to perform needed mSpI.'Ctions,
. ~k -;?:cr-
X . ~n~
ignature Contractor's License No. Date
Permit Valuation 2-/3-{JO. {)O
Permit Fee $ 74.75
Plan Check Fee $ --
State Surcharge $ I 2--<;
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
s Your Building Permit When Approved
-/-1, ~'}Oll
Dale
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # S
Builder's Deposit S
Other $
TOTAL DUE S 7'~7. 00
I Paid
Date
?f()O
'I. Z3. ()4-
I~; ~3&1
ThIS IS to certify tballhe request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requc'Sted, This document
when signed by the City Planner constttutcs a temporary Certificate of Zoninl compliance and allows construction to commence. Before occupancy, a Cc'rtiftcatc of Occupancy must be
issued
Planning Director
Date Special Conditions. if any
24 hour notice for all inspections (9!12) 447-9850. fax (952) 447-424!1
16200 Eagle Creek Avenue Prior Lake. MN 55372
..
PRIOR LAKE DEPARTMENT OF
BUilDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS /(tJ04-C; hc/lNKLIJV ~/L
TYPE OF WORK / ~ 11/ IL
USE OF BUILDING ~ __ '
PERMIT NO. Ot:/-. J / B / DATE ISSUED /1 Z.3. 64-
BUILDER I&Cj6/G.5 /Jt/7?). ~AI&5S PHONE # I 860. Zft;6. 8833
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
---- I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
~ I I
I FINAL I I
FOR ALL INSPECTIONS (952) 447-9850
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