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p PR/O, CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
�. r TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
i. x AND UTILITY CONNECTION PERMIT
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M / A'IV E SO
2.
I. whitePi Il File Cit y v i P ERMIT NO. ( O I
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(Please type or print and sign at bottom) 3 Yellow Applicant
ADDRESS
/5 't�s P ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
PID
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(Name) TckA, 5e...-1. (Act/I" In l ttA s g01 � ,3�/
I � (Phone) 3
S 3 S 3 cEas l ,os
(Address) � ►\ c v
BUILDER A ae_... (Company Name) / / T L' � P (Phone) 4 o
(Contact Name) M IX t -5c L p„\_,L4 y , c, ,_ (Phone) 4 Y 9 - 4 Cft
(Address) f1 s_ , el /N g t lt. ALP A t
TYPE OF WORK ❑ New Construction p E ❑porch
DAlteration ❑Re- Roofing ❑Re- Siding ❑Low evel Finish ❑Fireplace
[ ' A ddition ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C.
❑ Misc.
Type of Construction: I II III IV V AB
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $ Y On
Division: 1 2 3 4 5 (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 the building
official ca re .ke this p- mit for ju. cause F thermo. I hereby ` ;ree that the city official or a designee may enter upon the property to perform needed inspections.
..,/ . —.4,14A ' - ' ---- ..0.:2,1?? i 6--- `-/1.0r
Signature Contractor's License No. ��
Date
Permit Valuation 3 0 O 0. 0 T Park Support Fee #
V $
Permit Fee $ / /� e „ if-- SAC
U # $
Plan Check Fee $ W ater Meter Size 5 /8 "; 1 ";
��.31p $
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 $ /47 i )
This Application Becomes Your Building Permit When Approved
Paid /4(7 / / R ipt No. Co U //7
Date 20 (0 B l
Building Official Date
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
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 Special Conditions, if any
4646 Dakota Street Prior Lake, MN 55372
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS 5 - �� -
TYPE OF WORK 06-eX-
USE OF BUILDING L.
PERMIT NO. ! 1 . / Z 4 DATE ISSUED " • 10. •
BUILDER A/ ,, ' / ' 4&", PHONE # 44 CO
NOTE: THIS IS NOT A PERMIT FOR ANY
THE PERMIT IS BY SEPARATE DOCUMENT INSPECTIONS BELOW
INSPECTOR DATE
FOOTING 1 a 9/ I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED I
1 1 I
I FINAL
1 Pi6 `YA /1=? .
FOR ALL INSPECTIONS (952) 447 - 9850