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a/ PRI CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 4-, / Z, , I2_
.. x AND UTILITY CONNECTION PERMIT
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NES I. white File PERMIT NO .
2. Pink City t 7 �
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/6064- 7 /A/C / Ai W. r -z sd
LEGAL DESCRIPTION (office use only)
LOT / BLOCK -- ADDITION 'ice du/PfS OF A/0 /a "406 0 M v ' ' I WJPID 25. 459. �i (a. 0
OWNER C� 7
(Name) t_j C',0 1 PE /L fee) A (Phone) 4-06, - c° / Z
(Address)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck orch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
DAddition DAlteration ❑ tli Connection
CODE: [o.R.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 furnished 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. 1 am aware that the building
official can revoke this permit for just Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X
`/ /(; r % C
Signature Contractor's License No. Date
Permit Valuation 1 OOcr2 t Park Support Fee # $
Permit Fee $ i 41, 75 SAC # $
Plan Check Fee $ q � ' 1 i Water Meter Size 5/8 "; 1 "; $
F
State Surcharge $ 3 5Q 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 $ - 7 46 4'0
This Ap . ; atio B t es /.0 Building Permit When A .rov d Paid Z 4 / 4 . 7 Rey' 'pt No. 6,90 2 - , (.5
/� Date 4, / e - /z-- B
iA/4... �� I% ' 1. W--
-
Buildine Ofticia Date
This is to c that the . est in the above application and accompanying document in ace. dance with the City Zoning Ordinance and may proceed as requested. This document
when sly' . 'by t e Cit i r onstttutcs a temporary Certificate of Zoning compli cc and ows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued. n A i
P a _ . Date 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 DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS /(0061 VIMAI/e pLth
TYPE OF WORK
USE OF BUILDING /26.f
PERMIT NO. /ZZ. 210 DATE ISSUED 4 . /3. /Z
BUILDER PE/e ,i PHONE # 4'66. (/Z
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELO
THE PERMIT IS BY SEPARATE DOCUMENT
N ECTOR DATE
I I
PLACE NO CONCRETE UNTIL ABOVE H S EEN SIGNED
`FRAMING iii -,N� A ZL �`'� r v'' 6 - 1 5/5 1
l
a 7 z»r ot" Pi-'10'u 12°1-1()/
FINAL 1 Q �J I G H t
FOR ALL INSPECTIONS (952) 447 -9850