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(F PR CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE '
AND UTILITY CONNECTION PERMIT ''` . ' �-
40/NESolt• I. White File PERMIT NO
Pink Applicant
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2 Yellow Ap /S !l2��
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
9 1 o i, �, r rf ' E, ✓' L5, Mk. 5 1
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) f -14 n T - ve Kso n (Phone)
(Address)
BUILDER
(Company Name) MPrrl( .I- T Art( COrt -. Pie Plriwi Cohsl (Phone) 44 G I )-^ 9 `10 - S 5 s
(Contact Name) m cif 6 6r'ti,ck.` (Phone)
(Address) Litga Eq.k C'-/�► 1 - ,'
Ctck P r „ p.-- Lc k. /4 n 5
TYPE OF WORK ❑ New Construction Deck ❑Porch ❑Re- Roofing ❑Re- Siding ELower Level Finish ❑ Fireplace
El Addition ['Alter to ❑Utility Connection
CODE: .R.C. ❑LB.C.
❑ Misc. •
Type of onstruction: I II III IV V AB PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
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 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 aevoke thi ermit for just cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
Signature Contractor's License No. Date
Permit Valuation Zo ° Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ 41 • GI l ev Water Meter Size 5/8 "; 1 "; $
State Surcharge $ �` 1` � 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 1 $ TOTAL DUE $ I ZZ ` L I
This App .. .'o •comes Youi Building Permit en Ap roved Paid /�.� ‘j /Re No. �QSJ (G>
' '' Date ,j , � /�-
Bu ig Official Date
This is to r th, e request in the above application and accompanying docu nts is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when sign the ty Planner constitutes a temporary Certificate of Zoning co Hance an allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued
2 �— I Z—
'n Di ctor 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 AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS 5*D9 /50Th S S�
TYPE OF WORK DELL
USE OF BUILDING it7S -
PERMIT NO. 1Z- . /97 DATE ISSUED 3. Z(o. /2-
BUILDER 1 1 I e0NS772_ . PHONE 1# 4 9 41 /. 5SL`f-
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTO DATE
FOOTING 1 fig �
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
FINAL fL l
FOR ALL INSPECTIONS (952) 447 -9850