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PRi CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE /� y 0
f:::...r ... f , . x TEM AND UTILITY CONNECTION PERMIT -T I
M /N I. white File I 0
2. Pink City PERMIT NO . O 233
2
3 Yellow Applicant [���.��JJ/J
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/ /60 7Y e C; rz le /4/ , -- / - 2„; o f t ,,,,,/ SS 3 7/
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER TO- I� 1 _ r,, �j�✓ 1 (Name) N el 5 r ✓ `� (Phone) / ✓ - - Z _ /
4.57 - 30Y -7oz Cat(
(Address)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction 154peck EPorch ❑Re- Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
EAddition ❑Altera ion ['Utility Connection
CODE: O.R.C. ❑LB.C. ❑ Misc.
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
I hereby certify that I irnis%ed 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- mentione.. open) an. lat 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 r , oke this per ause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X y4 - 2a/ d
/ Signature Contractor's License No. Date
Permi iI aluation it-/ 0 00 0 0 Park Support Fee #
Permit Fee $ / U3 0 a SAC # $
Plan Check Fee $ (o 6 ,95 Water Meter Size 5/8 "; 1 "; $
State Surcharge $ 2.00 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 i ' / / 44. / /Q $ /71 f5
This • 0 , icati / Becomes Your Building Permit en A roved Paid / 7/ No) 7 Recei. No!, 016 Io
A 1 41 / 6 A 6....h Date 3 )O B
4Ii�/ Q' lZ., (
Bui1 Date
This is to c 'rtify tha he request in the above application and accompanying does ents in accordance with the City Zoning Ordinance and may proceed as requested. This document
when si. //. by t i ity Planner constitutes a temporary Certificate of Zoning a plia e and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued
/ la /
Planning Director l ate 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 /4/&O B4D BADIEg. elate'
TYPE OF WORK DeCX
USE OF BUILDING /00
PERMIT NO. / DATE ISSUED 4'. /L. 10
BUILDER BE PHONE #_353.427,5"
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR ATE I
IF NG I ` 1 1 -27 / 1-
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
IOWA 1 1
I FINAL 1 1
FOR ALL INSPECTIONS (952) 447 - 9850
Residential Building Permit Checklist
Det k Additions to Single Family owes
--� Date: 4 i z j 0
BY: t �
oning:
Building Permit #
—••■■ PID:
Site Address ( 4. t o � Vic, co , , •
Legal: L_
B____________ Subdivision:
Existing Structur ,
�rNO - -_
NO
CONFORMS TO ZONING
ORDINANCE LIMMr
Requirement
Proposed
Yard Setbacks: NOT APPLICABLE
10'
• Side Yard
(25' if abutting a street, 30' if abutting a street in -
Cardinal Ride 10' 3'.3 . Side Yard
J
• Rear Yard
• Must be consistent with
Townhouses approved plan for
develo . ment
ANY PROPOSED DECK MEETING THE ABOVE CRITERIA MUST BE REFERRED
BLUFF, THE KN
PLANNING DEPARTMENT. ALSO, ANY DECK ON A LOT WITH A SUSPEC T
OTHER
UNUSUAL CIRCUMSTANCE MUST BE REFERRED TO THE PLANNING DEPARTMENT.
THIS CHECKLIST MUST BE COMPLETED AND INCLUDED IN THE BUILDING PERMIT FILE TO
MAINTAIN A RECORD OF THE REVIEW.
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