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F PR /0 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
A. TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 0 • /�
AND UTILITY CONNECTION PERMIT
v x
' 2 Pink cty PERMIT NO. /2_ g/4_.
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
1 t S2,1 Laps Alie ,-ISD
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID Z5. 017 . 6G/. 0
OWNER f7 50roeiziffri- 60] -65'— h3
Name
(Phone)
(Addr ess)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction Fir eck ❑Porch ORe- Roofing ORe- Siding ❑Lower Level Finish 0 Fireplace
DAddition OAltera ion DUtility Connection
��
isc. ! `
CODE: L ]I.R.C. DI.B.C.
Type of Construction: I II III IV V AB PROJECT COST /VALUE $ l (/ //QQ��
Oo • 00
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
1 hereby certify that t 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 wi conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can rev , , rmit fo ust c�(f 'e, I . - .y agree that the city official or a designee may enter upon the property to perform neede inspections.
X /1► ►. t:�
A� Contractor's License No. Date
Permit Valuation. Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ .� 3 Water Meter Size 5/8 "; 1 "; $
State Surcharge $ �� Pressure Reducer $
7
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 6f sit $ 7 g., i\ 5
This A cation B Vim. Your Building Permit When pro ed Paid `'n. err
Date eipt No. 670 '
ate
r , i� y' r �,rZ� �.,
Buildine Ut is a D • to
This is to fy that the .ue t in the ab.ierappiicatron and accompanying docu -nts is i accordance with the City Zoning Ordinance and may proceed as requested. This document
when sig ,ri by th j j Can er constitutes a temporary Certificate of Zoning co pliance nd allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued . -
2-
` -.--, r ' '
PL ing Director to Special Conditions, if any
24 ho r notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372
L
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
SITE ADDRESS / (,0Z 7 L y Q S .4t/6.
TYPE OF WORK
USE OF BUILDING it
PERMIT NO. DATE ISSUED e. /3. ft-
BUILDER PHONE # 507.3SL 0043
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
IN P CTORR DATE
I
FOOTING 1 je `/ /ti5
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I FRAMING X'4,14,
I FINAL � �� I - �� - 3
FOR ALL INSPECTIONS (952) 447 -9850