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/ CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
I TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ✓ /
AND UTILITY CONNECTION PERMIT 7
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. Pink City PERMIT NO. z 73 0
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3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/4L g 2 If (4al4W t1•✓( 14 f 1 flfiott twe 4 ilSS3
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(N am) /.7 em 4 db., /44 I4f dde1 (Phone) 31 ' 3 IPT - 04 11
(Address) 4 dv7
BUILDER �
(Company Name) M OI✓' / . i La...Z. (Phone) 6(2 - ‘7; I '1144
(Contact Name) Avlieezi �(�+� C.1 Sit" ✓ C am , (Phone) 6( ' 5 ` / 14 -
(Address) S26 1..) Z, Jr- ; 4 , 00 A" ,/t ,•- Sri 2-
TYPE OF WORK ❑ New Construct!,on ['Deck ['Porch ❑Re- Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
❑Addition eration ['Utility Connection
CODE: E.R.C. DI.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 $ I ( /ST
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished ' formation : ..is 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 + c. stru• . - ill 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 ' / t c. s -. ore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X / — / / / / /�_ /3Cg 7- P-1Z
Signa e Contractor's License No. Date
Permit Valuation l b,O_ r- Park Support Fee # $
Permit Fee $ 6 7 , 2-5 SAC # $
Plan Check Fee $ 4*s - 1 I Water Meter Size 5/8"; 1"; $
State Surcharge $ q b 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 tY - D °1J i I 1 z. $ 1,1 8&
.
This +lication : , , , Your Building Permit Approved Paid /1 / 6 /(a. Re ipt No. 6) l t 1
1 /1 . Date / / 7 / Z,-- B
A .4 �'• Mk
Bu • ' - ;„i cial to
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 all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, 11Ennesota 55372
9
PRIOR LAKE BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS �(oZ� G,gQ.¢t,4.e,,�r
TYPE OF WORK t_ceYCA -tt
USE OF BUILDING r2-6s � �2
PERMIT NO. � Z "`��$ DATE ISSUED 1 (11 icz
BUILDER qetem *-,J PHONE li61z -Sg /- 99"1")
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN IGNED
FRAMING pi- lnsa.�,•
u�ats 1 F!'� 1 y �
(FINAL 1 I V-74)//
FOR ALL INSPECTIONS (952) 447 - 9850