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o4 PR /0+P CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
trj
� I. White File
��MN E SO� . NO. � 7 ' j3
3 Yellow Applicant
(Please-type or print and sign at bottom)
ADDRESS
�i q m /U ZONING (office use)
'TO 1 3 (t��lc h a bane E p,,,,, 1 LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER r � /
(Name) V 2 h U 1 1 1 , /\ a J� e (Phone) - 3 31 - 7 6 75
(Address) % (V . C v'-I c 6 w, a n 1_2 i r N
BUILDER s e i
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction Deck ❑Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish El Fireplace
❑Addition EAlter o ❑Utility Connection
CODE: .R.C. ❑I.B.C. ❑ Misc.
•
Type of construction: I II III IV V AB PROJECT COST /VALUE $ e , 00
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. 1 am aware that the building
official can revoke this permit for It t cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections. ,...4,_
X 4:=.,e hf Signature Contractor's License No. p Date
Permit Valuation Park Support Fee # $
Permit Fee $ se. ii," SAC # $
`
Plan Check Fee $ t7 7, • Water Meter Size 5/8 "; 1 "; $
State Surcharge $ 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 $ l t
This A L ati Becomes Your Building Permit ppro Paid �a�1_ Recei. t No. / /fir
' Date Al, LIIIMMMIIIINIII B RUM-Mill
4441.44161111".11111.1F. 4f
Br`ldineOtiicial - D te
This is to ertify that he request in the above application and accompanying docum . is is i accordance with the City Zoning Ordinance and may proceed as requested. This document
when si' ' by t • ity Planner constitutes a temporary Certificate of Zoning com lance nd allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued
h . '
COW iZ--
Planning Director L15 te 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 *-430 A- '0 ' 4
TYPE OF WORK A t 11 c A)
USE OF BUILDING l`'e A-
PERMIT NO. h DATE ISSUED "
BUILDER get-4-M) ( / ,i- PHONE # '1- ;3 t
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
N PECTOR DATE
I FOOTING 1 5' ;z 1
PLACE NO CONCRETE UNTIL AtiOVE''HAS BEEN SIGNED
Fr" r i t1/4)1-t . Z iC) (:-A 1 40//,
I FINAL a 6/4(
FOR ALL INSPECTIONS (952) 447 -9850