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• rP PRi CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE & _ r ` I
rn AND UTILITY CONNECTION PERMIT �
'd t. white File P . 1
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3 pink City ERMIT NO.
Y�. /I2—
3 Yellow Applicant �1
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/97f? V 7, 6-
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION �
OWNER PID
' r / • , ' � � /, ) — !
(Name) LJ �� J I o fv rz C'C. c e i, J ( Phone) v / • � � .
(Address) �� � '/ .. ---e.: / /'e'"4 /4 G S5' ! .,
BUILDER I , '' (Company Name) t, `� t 'J C ( G t s ,, ,4,.) (Phone)
(Contact Name) (Phone) 9t ') 6'7_ // r 7
1 (Address) 1 °. /. 4—L/` J St r e ` i — 44,--) 5 -- j
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch DRe-Roofing DRe-Siding DLower Level Finish ❑ Fireplace
❑Addition t]A3teration DUtility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V AB PROJECT • ST /VALUE $ CJ o6 •
Occupancy Group: A B E F HI MR S U (excluding d)
Division: 1 2 3 4 5 i
1 hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I Asp certify that m 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 submittc. Mans. I am aware that the building
official can revoke this permit for Just cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform nee. : nspections.
X ' � Signature Contractor's License No. Date \
Permit Valuation (ICY"- n � Park Support Fee # $
Permit Fee $ V 117 . • 5 " SAC # $
Plan Check Fee $ Z r • Stl_ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ z , 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 6 2 4 - c , 1 / $ /96 i
This • .. 1 a •.t , co1s Your Building Permit When Approved Paid Vila Q'l.tNo. /M �
Date 6 / /(
Bid, fticial 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 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 BUILDING A DOIN SPECTION
INSPECTION
RECORD Q
SITE ADDRESS /47 SS OrD SEAAJ/
TYPE OF WORK e 0F meH
USE OF BUILDING
PERMIT NO. DATE ISSUED
BUILDER WO rEdejlibV PHONE #
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FOOTING (I) c- 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
FRAMING �ci *(kto WG
FINAL /` . ,d
FOR ALL INSPECTIONS (952) 447 -9850
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