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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,_ ! ti TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Z � ,�
" t, ' AND UTILITY CONNECTION PERMIT
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N E SO
1. white File PERMIT NO. /2 _ 9) 3
2. Pink City
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/6frr o D Lii. Ave SE
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) I (O (t* da 54 .4.),45Tboci (Phone) 9,5-A- t30- P sly
(Address) IS 7 / neeier .. £Idol, Aks # 4 66141 ,) i /17/x/ S3 Y�/o
BUILDER `' ,f
(Company Name) f tear (c. itt WW1 &AS ftZ4 ?1 (Phone) 9 O.' ' 9'O `Y3 t i/
(Contact Name) 2.e..i. / 1O I36✓1 (Phone) /S 2-- o •Y34
(Address) y434 l✓ 1 rrik SF, ,S4t✓ i / 1 I N 5 (-G t( 9S1'30 .
TYPE OF WORK ❑ New Construction ['Deck ❑Porch ❑Re- Roofing ['Re-Siding ['Lower Level Finish ❑ Fireplace
['Addition IPPAlteration ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc:
Type of Construction: I II III IV V A B
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $ /G 5
Division: 1 2 3 4 5 (excluding land)
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 I 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 yoke ' rmit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed i ections.
X 7g3kL
Si Contractor's License No. Date
Permit Valuation / �+ Q o 6 , U 0 Park Support Fee # $
Permit Fee $ 4-1. L SAC # $
Plan Check Fee $ z 0 j Water Meter Size 5/8 "; 1 "; $
State Surcharge $ i� 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 (i �J(Z -W0 $ 69 b ...5
This Applicat o Becomes Your Building Permit When Approved Date d Receipt eceipt / & 7J�
�' y .._,Li
But mg Official 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 al! inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
..
PRIOR LAKE BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS I6'6O0 DlIC -(ITH A✓E
TYPE OF WORK �� ,p-- IjifTJ 'ON �il`iOD
USE OF BUILDING / c, tr,
PERMIT NO. / Z. P DATE ISSUED 5. I . l Z—
BUILDER FE - / p/9-�/Zs6q PHONE # Q5 . 14-7z NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
OWINIIIW I I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
FINAL 1 /4 1 813412
FOR ALL INSPECTIONS (952) 447 -9850
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DATE I. 1 U - PEt :MIT NO. I 'Z- • r
v E i x 9 C] ACCEPTED AS SUBMITTED
v E dK . 1 U WITH CORRECTiQNti n ; Nn't ?
1 x I ,, _ ❑ NOT ACCEPTED - CORRECT ., r" ,t , s . (h. , .
m g E ;§. -W s - N < r A , These comments are far our information >>:�
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Q 3 V -p ;{{ s Rau. A in full compliance with all applicable h&n int„ Y. xtxnr.iq a•,�.- ; -
• luifer118ntS Including dams not sEx_* +v , , , , ,t,-.4i { t , r. >.
KEEP THIS PLAN SET ON fi ,
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Separate permits are required
for Plumbing,. Heating
Outside Sewer and Water,
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