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OC "10CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
A TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
v
AND UTILITY CONNECTION PERMIT Iv
44 N E so 4t* 1 White File
2. Pink city PERMIT NO 12 _ G of
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
t4C3 .LI R ..7 Ets S 4,
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER p i
(Name) 1'-�1�ti .,..}- 4 rt...e., t l bl`.`c k d- (Phone) ` C4 - 303 - " c't ( j
(Address) ('tom ,44 `PV eils ..-j--
BUILDER
(Company Name) C--...- 1/4-x -■ 6.0 \SI B t . (Phone) `1 ce,I. ^ 1.4(40 - ¶1 Sc" �
(Contact Name) SC .) h.■ CA S ma y, (Phone) ((Pt).- R 40 ^ ? l O
(Address) ,: 2 '5 7 4 i~ cz ‘ , .1 k4.- - 1 s\ • S 1-t- TYPE OF WORK ❑ New Construction ( 6eck DPorch DRe- Roofing DRe- Siding ['Lower Level Finish ❑ Fireplace
DAddition ['Alteration ❑Utility Connection P
0 CODE: I.R.C. DI.B.C. cry
Type o o ction: I II III IV V AB PROJECT COST /VALUE $ , �t,Cr.)
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that 1 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 mentio.e. .roperty 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
oflit' an r is per r just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
Signature Contractor's License No. Date
Permit Valuation et e — Park Support Fee # $
Permit Fee $ ` � SAC # $
Plan Check Fee $ t 136. ( Water Meter Size 5/8 "; 1 "; $
State Surcharge $ -5 - 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 mk.0,09 tG , ( $ Zz_[ < (3
This Ap At , t � ' comes Your Building Permit n Ap oved Paid L Ll<-- Receipt N`o. (JC , � Date (0 -Li- ( 4 --- By Y' � %�
'tine Official Date
' ---.. " 110111 111111111W
This i s to it ify that t r if lest in the abovesypplication and accompanying docume is in cordance with the City Zoning Ordinance and may proceed as requested. This document
when s by t . C ' n , constitutes a temporary Certificate of Zoning corn ante a d allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issue
-4 5'3 fZ
P1ann g Direc . "/ ate Special Conditions, if any
r4 our notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372
PRI0R LAKE BUILDING AND �INSPECTION
INSPECTION
RECORD
SITE ADDRESS 14 jZv�t�Enx
TYPE OF WORK o6-c-w
USE OF BUILDING ,-mss h �
PERMIT NO. rZ'S)4' DATE ISSUED 57sr /z
BUILDER GA-“nlo ✓A PHONEN I 7.- - 1 4o - 7/45
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
JFOOTING 1 (>'//i I �� DATE
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
P laglintik%
I FINAL 1 ■4 I �S� /!
FOR ALL INSPECTIONS (952) 447 -9850