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1� CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd F ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT 53 ` / Z 4ri�'NESO I White File
2 Pink City PERMIT NO. /7 357
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS % ZONING (office use)
, `STI_Cb : t7.-\\As"\ - ;:\'K........ MA,-,-.7 . c,
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) P � c u \ , t _ �� ( Phone) \�" t `(Zj l I
(Address) '3 1LI-> .\.S1 , ` Yc &E \ (:\>_(..,
PAUL- GC72-4.
BUILDER ,
(Company Name) `YO.�� Z- �S U1\� Ii\ (Phone) icy '7 1 S1
(Contact Name) (Phone) (e /L . '75 . 33r Z-
(Address) (yf — ) , o` \-;-\- \ t / `` 1_
TYPE OF WORK ❑ New Construction ati<Crc DPorch ❑Re- Roofing ❑Re- Siding Lower Level Finish ❑ Fireplace
DAddition ['Alteration ['Utility Connection
CODE: LR.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V AB PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
1 hereby certify that 1 have himished 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 revoke this permit for just cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
I X
Signature Contractor's License No. Date
Permit Valuation 3, 00 U , O a Park Support Fee # $
Permit Fee $ 8 8 `ZS— SAC # $
Plan Check Fee $ S---7..3(o Water Meter Size 5/8 "; 1 "; $
State Surcharge $ / SZ) 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 $ f¢7 / /
This 1 . lie, T t n Becomes Yolr Building Permit en pproved Paid AP, / / R eipt No. 6 S 7_5' C
_ Date .`7 7. /
i lidding Official Date
This is to 4 ; ify th t t c request in the above application and accompanying documen is in ordance with the City Zoning Ordinance and may proceed as requested. This document
when si 7. by City Planner constitutes a temporary Certificate of Zoning comp ance a' • allows construction to commence. Before occupancy, a Certificate of Occupancy must he
issue —
Z
1 Planning is'. + tr. . 11: to Special Conditions, if any
4 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
—_� 4646 Dakota Street Prior Lake, MN 55372
PRIOR LAKE RI DEATMENT
OR LAKE AND OINSPECTION
INSPECTION
RECORD
SITE ADDRESS 3�POINTE PASS
TYPE OF WORK
USE OF BUILDING l h .
PERMIT NO. D ATE ISSUED leiltZ
BUILDER S PHONE #
NOTE: THIS I NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
1 FOOTING/1)0A,, Qi6 01,2, I 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
l 1 1
FINAL 1 � � g � �' /
FOR ALL INSPECTIONS (952) 447 - 9850