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� F PRIj CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 7 b / 0
- AND UTILITY CONNECTION PERMIT
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M'I'NESOlP I. White File
2. Pink City PERMIT NO. to . 6 , 3 5-
3 Yellow Applicant
Jeaeetrpe or rint and sign at bottom)
A DDRESS ZONING (office use)
5 703 bircimdood AVC- NE 55 2
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
/k/ , c k"-ti 07 , I,, IhS /y0h+4i .ragik.►1I (Phone) 1S2. — i i7b
(Address) 70 I r •/ Ave.., r i 6 ✓" All 7
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone) `\
(Address)
TYPE OF WORK ❑ New Construction ck ❑Porch ['Re-Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
['Addition ['Ake do EUtility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B PROJECT COST /VALUE $
Occupancy Group: A B E F II I M R S U
Division: 1 2 3 4 5 (excluding land)
1 hereby certify t 4 ave / rnished i mation on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authoriz •• agent for the
above- menttone . I erty d that al instruction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I a aware at the building
official can revo • pert it for just • Ise,o Ftyhermore, I hereby agree that the city official or a designee may enter upon the property to perform needed mspe• ions.
/� � X I
�� Contractor's License No. r D to
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Permit Valuation Park Support Fee # $
Permit Fee $ '88. 25 ' SAC # $
Plan Check Fee $ .5 ?/ 7 Water Meter Size 5/8 "; 1 ", $
State Surcharge $ /. J 50 10 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, / /
This Applicati,r /' •'t Your Building Permit When Approved Paid / 7 (( R eipt No. 6 (O /Z_
,./iii Date -7 20_ /C.) •
• tii ing Official Date
This is to ■ 'rtify 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 sig 'd 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 BUILDRNG AND ONSPECTION
INSPECTION
RECORD
SITE ADDRESS 5703 F.)/lZ'�W. 4�4-;
TYPE OF WORK vt N�
USE OF BUILDING �i� /9//C
PERMIT NO. /O 635 DATE ISSUED 7. 3 d O � v
BUILDER S //'// PHONE # ( 0W ,
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
FOOTING � � E � 7 � lC) DATE I
PLACE NO CONCRETE UNTIL ABOVE AS BEEN SIGNED
011111111111 I
FINAL 1 � 3�5 ,
FOR ALL INSPECTIONS (952) 447 -9850
UNIIROAN Main Office 571 6006 ®,
Ilk inn Highway N.E. y> ->3
EinNOIN * *IRI
IeK. Minneapolis, Minnesota 55432
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,pli South Office 8!105510
Civil i Municipal Ertl/sneering • Sail • ?Mine • Lan( , SurvyuV •Ise/ 148414041 gi Burnsville, Minnesota 55337
-Certificate of Survey- for WIA10602 DEVEL opine r
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