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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
dr �'N E S OA
. White City e File
2 Pi
. Pink PERMIT NO. 40... YG 6
2
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
5 S W9 Taxi 11,1e-Abi L A ne ?r, r 1. :ak 4? .i 553
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) hi c ,K Mr-c) t Pf"` (P hone) e / Z – � � U ` ci'J 3
(Address) 55 j im , / I-10.44.4 1 G.t. ?d^i r, r" 1-0,k C 't/ ,1/
BUILDER
(Company Name) —_ "
(Phone)
(Contact Name) .. __ _._._...... (Phone)
(Address) _.
TYPE OF WORK 0 New Construction ,beck OPorch ORe- Roofing ORe- Siding OLower Level Finish 0 Fireplace
. OAddition OAlteration OUtility Connection
CODE: DI.R.C. DI.B.C. 0 Misc:
Type of Construction: I II III IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COST /VALUE $
Division: 1 2 3 4 5 (exdu4 o 1, d)
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 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 ware that the building
official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter the
upon property to perform needed inspections.
% Z-`_ / -" r te a ---. _. /% r — Zeia
Signature Contractor's License No. Date
Permit Valuation �,. 00 Park Support Fee # $
Permit Fee $ ?3..x,5 SAC # $
Plan Check Fee $ q 7.14 Water Meter Size 5/8 "; 1 "; $
State Surcharge $ Pressure Reducer $
I.6D
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechaniral Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ hoZZ • G%
,
on . Your Banding Permit When Approved Paid I.I', No. *2
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MIGIPA, ` Date BY !'/
. 6 ( vip
Buildi ' g 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
issued. Occupancy must be
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS 5 5(9 7 29'V
TYPE OF WORK OLNC
USE OF BUILDING 7Z-CT -
PERMIT NO. /0 DATE ISSUED 6, 3
BUILDER /C/U yb/C- PHONE # 6/0, 766,6P72.1
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FOOTING , 1 f2, 6/(4,,
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I FRAMING kj c J t ? / 1
I FINAL 1 1
FOR ALL INSPECTIONS (952) 447 -9850