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ot.. F PR!' " CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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4 4NESOo R 1. white File A
2 Pink le PERMIT NO
3 j Z Tom_ j_{167
Yellow Applicant l 4 -
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/5294. E6G €I..,./R-7'EK G flrzcL.c cam, (Alc.e
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) ✓r•tI (Phone) 6 /2_- 4il 8-37 B
(Address)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction I: II eck DPorch DRe- Roofing Erne- Siding ❑Lower Level Finish 0 Fireplace
❑Addition DAlteration DUtility Connection
CODE: I.R.C. DI.B.C. 0 Misc.
Type of onstruction: I II III IV V AB
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $
Division: 1 2 3 4 5
(excluding land)
A _
I hereby certify that I have fur ' hed 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 -menu. , 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 reT't aj.}st cau . lhermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X �� -. .
ature Contractor's License No. Date
Permit Valuation d Park Support Fee # $
Permit Fee $ Z-5 SAC # $
Plan Check Fee $ / :3o Water Meter Size 5/8 "; 1"; $
State Surcharge $ ( ��� Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $ ■
i
Sewer & Water Permit Fee $ Other $ \
Gas Fireplace Permit Fee $ TOTAL DUE $ 4"7 \
This h licatio �: omes Your,Building Permit Whe Appr ed Paid 7 f Receipt o. ` ? 767
�v Date � By /�'i� /
Building Official Date
This is to ify that th. r .ucst in theRtbove application and accompanying docu ents is i accordance with the City Zoning Ordinance and may proceed as requested. This document
when si. fd by t Ci'" a er constitutes a temporary Certificate of Zoning co pliance nd allows construction to commence. Before occupancy, a Cerntcate of Occupancy must be
issued. n r l S i //� PK
. i _ , G.- lh/"
Pan - `• tor to 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 �NSPECTION
INSPECTION
RECORD
SITE ADDRESS l52% 61,d�./9-fCS/L
TYPE OF WORK /7.....e-Atdrost3-o"-K--
USE OF BUILDING /2-'-ii--
PERMIT NO. z DATE ISSUED
1
BUILDER de.t.W ,vyeg- PHONE #‘i y - Q- (b
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR D�7E
I FOOTING / ��u��l �- q .� , 1 I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
FINAL /
F R ALL INSPECTIONS (952) 447 -9850
(07