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o* PRi R CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
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TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 6 1 1_ 1 1
AND UTILITY CONNECTION PERMIT
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44A,NESO4t' I. white File
2. Pink City PERM 1 IT NO . 7
3 Yellow Applicant (.
(Please type or print and sign at bottom)
ADDRESS DRESS ZONING (office use)
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W o ock a„. v 14 -- k - f'r -� ;_` / --__ /Z /SD
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID 25_ 4-0¢ b6Z. 0
(Name) a, v.-4 ( 0 kcA:t.5 ( -e-° (Phone)
(Address) l 4 0 0 LJJ 0C) L.G. to.0 K l / ; `
BUILDER ^--- nn ^
(Company Name) rt.. 11..- c- K I (Phone) (9 ( d- — 19 ` - 0 — 1 1 `? 7
(Contact Name) ' '- 7I h- ?r (Phone)
(Address) .... 1-(c(0 (• .-•-n �„.- (..a► .R', ov. e 'kr tA..A.eekS , ti (-1-+ v" tM c KS . ( o
TYPE OF WORK ❑ New Construction ['Deck ❑Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
['Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. XMisc. .5CR2EA/ /A/ EC i STO■il piArr -o/e/1
Type of Construction: I II III IV V AB /9"11'
PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5 i
1 hereby certify that 1 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 w . . m to all existin: state and local laws and will proceed in accordance with submitted plans. 1 am aware that the building
official can revoke •ermit . just cause. Further . • - reby a. . t the city official or a designee may enter upon the property to perform needed inspections
X _ _ a- U Ce.ict L IU 1r (I 1 l
Si 1 + atu � Wr Contractor's License No. Date'
Permit Valuation Park Support Fee # $
Permit Fee $ 41 Z5 SAC # $
Plan Check Fee $ UI. S ( Water Meter Size 5/8 "; 1 "; $ •
State Surcharge $ ill t :J G}-1 v 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 S. 5
This ica b '. com: ou : uilding Permit When ppr ved Paid 7 Re pt NO. �3 �Z w
/.I/ 04I ' a Date 5 , /r.[ l B
• iildins Official D. e
This rs to ce. fy that the request in the above application and accompanying docu nts is n accordance with the City Zoning Ordinance and may proceed as requested. This document
when sign y the it ; P' nner constitutes a temporary Certificate of Zoning co lianc and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued
A / . . : , _ 5« tl
Planning Dire ate 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 DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS /4170 WOOD doveg 7t __ TYPE OF WORK S V ffi infi7 i #/
USE OF BUILDING
PERMIT NO. DATE ISSUED ;Arm
BUILDER PHONE # Ga. 2410.7 07
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
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PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SI NED
I 1 1
I FINAL 1 6 I vv,
FOR ALL INSPECTIONS (952) 447 - 9850