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of PR CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
:: TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
' x AND UTILITY CONNECTION PERMIT
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PERMIT NO
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(Please type or print and sign at bottom)
V ADDRESS ZONING (office use)
1 14 9 R S G( M M L[ C_, i t(- C L C. Ai ve(
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) ✓ 1 f1. C jc,\ J t \ (Phone) C (`) L — L3 3 — l 3 (,...:5
(Address) _ () <( f L NI
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ['Porch ❑Re- Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
❑Addition ['Alteration ❑Utility Connection Q
CODE: ❑I.R.C. ❑I.B.C.
F - Mist. t` 67 A't I► F ib*.
Type of Construction: I II III IV V A B PROJECT COST /VALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
• 1 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 Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X `� l ,/ /�_ 4 ∎..�..........-
Signature Contractor's License No. Date
Permit Valuation Boo Park Support Fee # $
Permit Fee $ - ' .L =/ S . (9e, SAC # $
Plan Check Fee $ KO. .2. Water Meter Size 5/8 "; 1 "; $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ 41 . 1
This / . r
'ca . • Becomes Your Building Permit Wh A oved Paid /�� — �
Recei.t No u► 1 d
i Date - SIMI— B 1 Al
u Iding Otticla ate
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
4646 Dakota Street Prior Lake, MN 55372
•
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS 1,414 5r-c'c tr C P.C.A.
TYPE OF WORK
USE OF BUILDING S Ale__
PERMIT NO. DATE ISSUED c4/2 /lo
BUILDER 8r7.-.• •, >hJ is PHONE # Sr, •z33. 1 365'
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FOOTING I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I FRAMING 1
I FINAL v.)v kaIN 1 379(2
FOR ALL INSPECTIONS (952) 447 -9850
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