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of PRi CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
A TEMPORARY CERTIFICATE OF ZONING COMPLIANCE / Q /Q
'"" A... r ittik e
,..) .,... v t p: ,,
AND UTILITY CONNECTION PERMIT
sI qP I. white File PERMIT NO. s
Nveso / 0
2. Pi C i ty
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
1 574(p &c-rc1 Ti ME ?r,ct L6kQ M'f1J
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER L9',.. I' 1� �� .r s `
. meke1 13 e5 w r
L
e) (Phone) ?�,,Z. In
(Address)
I
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch DRe-Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition DAlteration ['Utility Connection
CODE: R.C. ❑I.B.C.
*isc.
5 --- /2- X I Z
Type of Construction: I II III IV V A 13 PROJECT COST /VALUE $
Occupancy Group: A B E F III MR S U (excluding land)
Division: 1 2 3 4 5 i
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 can revo this permit for just cause. Furt ore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspe tions.
7 6'? .
Signature ��) Contractor's License No. Date
7 ��,
Permit Valuation r/i / Park Support Fee _ # $
Permit Fee $ irs1=3- SAC # $
Plan Check Fee $ 57 , 2 , Water Meter Size 5/8 "; 1 "; $
State Surcharge $ t '5.° 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 $ (4./ . 1
This A . . i io ecomes Your Bttilding�ermit Whe Ap roved Paid / #7, /1 Rec t No. (o/
Date /0. 7. / 0 B
Buildint fticial D, e
This is to cert� that t request in t a application and accompanying doc men is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed jI e C Planner constitutes a temporary Certificate of Zoning mpli nce and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued �, ..•
I P ' - sing Director ate Special Conditions, if any
24 hour notice for al inspections (952) 447 - 9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372
PRIOR LAKE
P DEATMENT RIOR LA AND ONSPECTION
INSPECTION
RECORD
SITE ADDRESS 5 4-& C:60/1/&44/06
TYPE OF WORK � ` SS -5 f/ /Z-E
USE OF BUILDING /2,63 4/8_
PERMIT NO. /O. a9/ DATE ISSUED !O, 6 . / U
BUILDER /'i PHONE # 4 J34-3
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
- HE PZ/R6EM j PJS ' %V/3
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
FINAL 1 O t�/7��D
FOR ALL INSPECTIONS (952) 447 -9850