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PR J CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE a
AND UTILITY CONNECTION PER U c. ' IL
U en
�'NNEscry I. White File
2 PERMIT NO ry
. Pink City / / o g '6
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
VI l Z-00 (41-4 lie- 4,/ Al 6.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER q (Name) • C/ �t'Qc.1C.t� (Phone) 4 - z 7'' 3 �. �' 7
(Address) 1 [ / /'. l<.- 6 £.
BUILDER �+ � � -
(Company Name) C� � 4 Cie n j , - /c..e4 £& (Phone) Ste 414 ' tZ
(Contact Name) 6 Akw/ 41 (Phone)
(Address) Co C117 94 SQL. �i, Gage-
TYPE OF WORK ❑ New Construction Opeck ❑Porch DRe-Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
DAddition ❑Alteration ❑Utility Connection
CODE: I.R.C. ❑I.B.C. El Misc. `
Type of o struction: I II III IV V AB
PROJECT COST /VALUE $ 5� '
Occupancy Group: A B E F HI MR S U
(excluding land)
Division: 1 2 3 4 5 i
1 hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. 1 also certify that I am the owner or authorized agent for the
above -menu proper and -t 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 ca evo e this rmr Ist cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
1-f; Signature Contractor's License No. Date
Permit Valuation /a7 6 Q e Q Park Support Fee # $
Permit Fee $ 6 , 75- SAC # $
Plan Check Fee $ 3 9 4-ei Water Meter Size 5/8 "; 1 "; $
State Surcharge $ # P n 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 0060 G' is . ‘2._ $ / / 04—
/icatiun Ts A me Your,puilding Permit Wh Ap oved Paid /01. t) Re t No. �s/ 6 7
(� Date 7. 2
Building • - ate
This is to certify It the requ • i the above applic and accompanying document is in a cordance with the City Zoning Ordinance and may proceed as requested. This document
when signed b / T e City P an • nst rtes a temporary Certificate of Zoning compli ce a allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued
kt. ' ILA 0 Z
' .nnin lire . 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 AIRTAL/6
SITE ADDRESS /4z OO OO IW.
TYP E OF WORK Dersx.
.
USE OF BUILDING I� ! O
�. Q
PERMIT NO. /2. 87(O A TE ISSUED .G. /L �
BUILDER �� dO�.nIJQlO �
PHONE N d. -rpm
NOTE: THIS IS NOT A PERMIT FOR AN F THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FOOTING WL I P � ��Z✓ /N7/
PLACE NO CONCRETE UNTIL ABOV HAS BEEN SIGNED
FINAL I
FOR ALL INSPECTIONS (952) 447 -9850
Scott County, MN
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Building Date 4.
Zoning,. / Date L!
Grading . _....." Dote. - ._ ,
This drawing is neither a legally recorded map nor a survey and is not Map Scale N
intended to be used as one. This drawing is 8 compilation of records, 1 inch = 41 feet
information, and data located in various c county, and state offices, and
other sources affecting the area shown, and is to be used for reference W E y .■..k.
purposes . Scott County is not responsible for any inaccuracies herein
contained. If discrepancies are found, please contact the Scott County Map Date �.
Surveyors office. 8/6/2012 s