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O F P _ CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
U 7 AND UTILITY CONNECTION PERMIT // / / Z
4'•iyrESOl° t. white File 2. Pink City PERMIT NO .
12 - 1
3 C� t�1 G
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
3 3 7? .51/4/44-7 c 7 54-7 /4", t er2 LeK6 ziyk. S$' a
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) /4 i- ‘6277/L4i✓ (Phone) CO/ -- .. 2 ,08 - e5
(Address)jot i l.-S /
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction ODeck ❑Porch ORe- Roofing ORe- Siding ❑Lower Level Finish 0 Fireplace
['Addition ['Alteration ['Utility Connection
CODE: DI.R.C. DI.B.C. O Misc. Lk X t �s sti
Type of Construction: I II III IV V A B
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $
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 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 revo e this permit for just cause. Furthermore, 1 hereby agree that the city official or a designee may enter upon the property to perform needed i spections.
X f' 17, i !i IFA
Signature Contractor's License No. Date
Permit Valuation 4000, — Park Support Fee # $
Permit Fee $ t e 3 . _ SAC # $
Plan Check Fee $ C000 , 1 5r Water Meter Size 5/8 "; 1 "; $
State Surcharge $ 2 _ _ Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee f $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ I 1 ( • c l. 5
This A ; I'ca ' ■ n Becomes Your Building Permit en , , proved Paid 1-1 L lc; ' Receipt No. d 662
/�/ , _._____ _ Date t1 I I1 1 (2 By 2 ( --
uildin ilft— Dato
This is t certify that the request in the above application and accompanying •ocume s is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when d y he City Planner epnsntutes a temporary Certificate of Zorn f g comp! ance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issue
(/ f i 2-
anm r 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 33 3e=i aN
TYPE OF WORK I I l S �1-t-
USE OF BUILDING Res AA&
PERMIT NO. ( DATE ISSUED i ' °I )12-
BUILDER (404.1 rte. Gc.atK�.�+ PHONE # 6,51 - 7-06-94.3 2_
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FOOTING 1 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
*UMW 1 1
I FINAL > i 1 '/I 1 J1 2`y _
FOR ALL INSPECTIONS (952) 447 - 9850
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