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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
.
AND UTILITY CONNECTION PERMIT
t, =
', NNESC 4P I. White File
2. Pink City PERMIT NO .
p 3 Yellow Applicant 1 1 - 324
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
5 COvA .-k—
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER �. v".J Q 1 , �� � v.5 (Phone) 9_S 2----- (Name) i�
(Address) 5 Co NAS SA SE
BUILDER
(Company g 4 fl — a9 ai
(Company Name) -Pe Q V1.5 uG O VI (Phone) -
(Contact Name) -2c j l -- Pe�_V S (Phone) a- S i ^ 14-5 0
(Address)
TYPE OF WORK New Construction ❑Deck ❑Porch ['Re-Roofing ❑Re- Siding ELower Level Finish ❑ Fireplace
A ddition ❑Alteration ['Utility 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 HI MR S U (excluding land)
Division: 1 2 3 4 5
1 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 1 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 this permit for ju Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
' X ��
ignature
Contractor's License No. Date
Permit Valuation S 00 - Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ l ZS Water Meter Size 5/8"; 1 "; $
State Surcharge $ 5-c) 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. (( --
This Applicat'o Bec mes Your Building Permit When Approved Paid 4-r.--/-) Receipt OS 1
Date 1671/ By OS -
s � /
Buildin Official Date
This is to certify that the requ •st 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 P er constitutes a temporary Certificate of Zoning complia. ce a, • allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued
5 t
Planning 1 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
_ • SAPP% • 61 . 0 7 . 4 , T■SPVY" ImPri1.11111
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS S •
TYPE OF WORK 13A-<- a o P i Tt o+J
USE OF BUILDING Res sk /rz
PERMIT NO. (k- 324 DATE ISSUED 5 (3 /t
BUILDER 13(L S PHONE # c,1 - Z9aj
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
*WM. f\1 A- 1 / IA 1 q(4ff
PLACE NO CONCRETE UNTIL ABOVE HAS pEEN IGNED
I FRAMING 1 i- 1
I FINAL I /0 /3//il
J
FOR ALL INSPECTIONS (952) 447 -9850