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O1 PR/ CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ,,/ / z 12—
en AND UTILITY CONNECTION PERMIT `�'
en v x
44 NEs it* I. White File
" 2 Pink City PERMIT NO. / / ,
3 Yellow Applicant -
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
'Sr 70 &A/Yew h --- r r zL S (.....
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER (2 L
(Name) it) 1 f v J S + C 1s • • r t � • (Phone)
(Address)
(Co DER �b � I ( } VI 1 Y �w� p/
(Company Name) S ( Phone) � � Z — O 10 7" ?79
(Contact Name) ' 1 ri i ✓Ii t o. �-S L..' (Phone)
(Address) (,16 7 o L ict b1L.L
TYPE OF WORK ❑ New Construction ['Deck ❑Porch ❑Re- Roofing ❑Re- Siding ['Lower Level Finish El Fireplace
['Addition ['Alteration ❑Utility Connection
CODE: �LR.C. ❑LB.C. H,Misc i. - f a . 't . ,I , - j ,. ,e l = /-- ', -F: i/_.
Type of Construction: I II HI 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
I hereby certify that 1 have furnished information on this application which is to the best of my knowledge true and correct. 1 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 revoke this permit for just cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X � - „-- c, f v, - 3 z
Signature Contractor's License No. Date
Permit Valuation cod,o.- - Park Support Fee # $
Permit Fee $ i t:1 a -' SAC # $
Plan Check Fee $ 1 4 Water Meter Size 5/8 "; 1 "; $
State Surcharge $ Z , 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 ;1.. I 7 , i - $ 1 6 ,1et
p/
This A icat'.n ' om our B{ding Permit Wh Ap roved Paid /% , 7 9 R tpt No. 6•54
Date „ / -/Z—
Building Offl .. I ,,O Dat
.■
This is to certify that th • r •quest 'n the above application and accompanying come is is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when sign ., .y th ; C •lann• constitutes ix temporary Certificate of Zoni comp ante and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued
i
Planning ' - • 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 3570 WIu t' c7?-
TYPE OF WORK [1/71- `-- Of) / '2/-) 6C
USE OF BUILDING %e-- CS ,t / /(_
PERMIT NO. a- ?1 ` DATE ISSUED - 1 z- /
BUILDER 9 0 C i t _ - ' f f PHONE # 6, ( , 7 . 3
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
NM I I I y P E NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
1 FRAMIN / ot.,/3 - 7704 1 71- 0. -- 1 I
1 FINAL 1 ill
5 fr'tv I
• FOR ALL INSPECTIONS (952) 447 - 9850