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t f pR CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE .
U X
tn AND UTILITY CONNECTION PERMIT ta- /Z, . /L
�4NesoSP I. went! Fitt
2. hit City PERMIT NO / 2 ✓ 50 A
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
7Z1 Li aufrOak S E
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER j� A ' Phon f iZ - - ` � /O 1 61 7
(Name) Zell s IV 66 Aul ( ) /
(Address) S PAVV Q.
BUILDER
(Company Name) P' 1� II �� IC49,,I I n .et k cl
e I( c (Phone) f5Z � lZ Z
(Contact Name) '. ?)f 0.h� (Phone) /Z" - 3 LB/ 3 I-L/
(Address) L/v 1 0- -AO S
TYPE OF WORK ❑ New Construction ❑Dr 4C X ['Porch ❑Re- Roofing ❑Residing ['Lower Level Finish ❑ Fireplace
❑Addition ❑Alteratio ['Utility Connection ❑ Misc. L�
• CODE: U LR.C. DI.B.C. POr - o chief eX■Sh. a P ROJECT COST /VALUE $ �` ��
Type of Construction: I II HI IV V A B (excluding land)
Occupancy Group: A B E F H I M R S U
Division: 1 2 3 4 5
I 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 authonzed 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. 1 am aware that the building
official can is p us` use. Furthermore. I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X " ■ 00 /71 / Z —1Z—
Signature Contractor's License No. Date
Permit Valuation 5 — Park Support Fee # $
Permit Fee $ 1.-q ' SAC # $
Plan Check Fee $ � Water Meter Size 5/8 "; 1 "; S
- 4
State Surcharge $ ,'� Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee S Other $
Gas Fireplace Permit Fee S TOTAL DUE (A (I t ti i2.. $ 4f,. 75" .
This • lira % • BecomesYot r Building Permit en proved Paid , 9'1. 7 Recei o. (4 Z,2,7
Date 6,.. / q. /7„. By _
Ail 12■—■11111 6 i ( B f dding O Da
This is to ' ify th t 1 request in the above application and accompanying docu nts • accordance with the City Zoning Ordinance and may proceed as requested. This document
when s : ,y by th C f fanner constitutes a temporary Certificate of Zoning co plan and allows construction to commence. Before occupancy. a Certificate of Occupancy must be
issued. /
' 7R g Director to Special Conditions, if any .
24 hour notice for all inspections (952) 447- 9850, fax (952) 447 -4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
PRIOR LAKE DB D I NSPECTION
INSPECTION
RECORD
SITE ADDRESS 1 (44 'IZiS 50-14 -
TYPE OF WORK Fats-AA
USE OF BUILDING
PERMIT NO. (z-Sb3 DATE ISSUED 61(5 ( Z,
BUILDER P4-9 6 PHONEH 6(L- 3Z9.(0¢
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
*QPIg rat,—.
INSPECTOR DATE
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I FINAL 1 yp
FOR ALL INSPECTIONS (952) 447 -9850