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o P R o CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
. ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE j/2__ AND UTILITY CONNECTION PERMIT _
U („
' i White File
2. Pins: City PERMIT NO. ! e ..._/4,./
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
)765 L €J y- j}•Q
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER II
(Name) 1 ML kci 0 (Phone) 50 7 y 9 2933
(Address) 1 - 7 0 s 13-e' 0'10 M'r
BUILDER
(Company Name) Fic0i l le k. (G n5'fnAC -f 1011 LC_L- (Phone) (12 2 3D- 9.,, '-/
(Contact Name) AU IAA i e Fri& hek- (Phone)
(Address) /153 Nat 5f J iV-e ) o a sd.ci /Q Aoki S V b
TYPE OF WORK ❑ New Construction Ir' P eck orch ❑Re- Roofing ['Re-Siding ['Lower Level Finish El Fireplace
❑Addition ❑AlteratiIn ❑U lity Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc. 2
Type of Construction: I II III IV V AB PROJECT COST /VALUE $ / 3 ,3 0
Occupancy Group: A B E F HI MR S U /
(excluding land)
Division: 1 2 3 4 5
thereby 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 r kethis pe it for 1 t cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X 1 �- 66 630 1 1 3 —6 I Z-
Signature Contractor's License No. Date
Permit Valuation 13 Q OO Park Support Fee # $
Permit Fee $ � 35 75 SAC # $
Plan Check Fee $ 153.2T Water Meter Size 5/8 "; 1 "; $
State Surcharge $ CO / CD 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 ' ' $ 3?3T V f
Thi . p y ic,. Beco/ es Your Building Permit When Approved Paid J R ipt No. ( 1.51 - 3 G
/ / Date 3, �_ Z B
r ha...
/ r iicial II 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 DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS I 705 vv o
TYPE OF WORK SorQ.eA iec1c
USE OF BUILDING SFL>
PERMIT NO. 12 — 1q9 DATE ISSUED 3N/2
BUILDER gravid- Orms . LL C PHONE # (-/2-x �
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FOOTING W c„ 10b / 1 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
i
I FINAL lljo c. • 1 / f,z//_ _ 1 1
FOR ALL INSPECTIONS (952) 447 -9850