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P12 /r CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
y TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 3 25-, t l
AND UTILITY CONNECTION PERMIT
M�ivNESO 1. White File
2. Pink City PERMIT NO. t I • !70
3 Yellow Applicant K�
(Please type or print and sign at bottom)
ADDRESS 1 ZONING (office use)
/6 r.ii-, Pt. /8-? o c-7 ,
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) tt4 *. ?x' (Phone)
(Address) /S3.4c, kst-. Pt. Ret
BUILDER
(Company Name) 4r- STUJ'- C a. -,-+t e' o (Phone) (7l e-1 ei 7- -e%1-[' -/C a
(Contact Name) Alcf. 4J P I,4efftL- J#f[.A (Phone)
(Address) /64/6 „L•L
. 0 ,A-
TYPE OF WORK ❑ New Constr ction ['Deck ['Porch ['Re-Roofing ❑Re- Siding ELower Level Finish ❑ Fireplace
['Addition Alteration ❑Utility Connection
CODE: DI.R.C. ❑I.B.C.
❑ Misc. 6i9' Z /`1 /rCi7 .
Type of Construction: I II III IV V AB PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U
Division: 1 2 3 4 5 (excluding land)
1 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 revoke is permit for ' . st cause Furthermore, I hereby ;- ee that the city official or a designee may enter upon the property t..erform needed inspections.
, r.3"S� 3 • s —
X �� Contractor's 2�
- - S g • � �� License No D to
Permit Valuation 5-1n) — ( Park Support Fee # $
Permit Fee $ --c (}A SAC # $
Plan Check Fee $ 1 L . ZS Water Meter Size 5/8 "; 1 "; $
State Surcharge $ SD Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ 5 s-3 Water Tower Fee # $
Mechanical Permit Fee $ _ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ /_ . Z5
This Application 1 • c. mes Your Building Permit When Approved Paid 4 L . 2-. T Receip o. , al (0,5
141' Date 3.2.r. If By
3, n li
Building! Ificial Date
This is to certify that t e 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 Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372
I
r �
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS l '5 4-6 ft st
TYPE OF WORK N T . . L, I . Cg R-N
USE OF BUILDING Q.i&S k`�--
PERMIT NO. t I - t7 L DATE ISSUED 3 - ZS
BUILDER C.Zof\t°s1 PHONE # (0S - t 4-51 . o 4
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
Et,E, + L . 1. 1 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
1 FRAMING / I N 5 U lA= Tl 0 NJ/ 1
6L( Get, F+ tJ i
I FINAL P 1 1 It
visaed PR e ()A '//V('
FOR ALL INSPECTIONS (952) 447 - 9850
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