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O* PR/04, CITY OF PRIOR LAKE BUILDING PERMIT,
Date Recd 1
a • TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 9. � � J
x AND UTILITY CONNECTION PERMIT !! U t �
I. white File
2. Pink City PERMIT NO. / / , 9 / Z....1 41NNESOl�
......,! 3 Yellow Applicant
(Please type or print and sign at bottom) ZONING (office use)
ADDRESS
& 1 k t.s b Ny t_
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER ` r \ _ S °� k55-q2,11
(Name) �Je- rw�.itCt�. �--a V �i v� (Phone)
(Address)
BUILDER (Phone)
(Company Name)
(Phone)
(Contact Name)
(Address)
5',' lr'
TYPE OF WORK ❑ New Construction ` Deck P Connection
❑Re- Siding
❑Lower Level Finish ❑Fireplace
['Addition ❑Altera •
❑ Misc.
CODE: ❑I.R.C. DI.B.C.
Type of Construction: I II III IV V A B PROJECT COST /VALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I ove -ment oned and that all constru this ill conform to alexisting stat best
and local laws and will pro e d in accordance with that submitted plan n I am authorized are that the building
a
b
official can revoke this permit for rust cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections. � � I
1 l U^I.
X ` •►.�W� - Contractor License No. Date
Signature
Permit Valuation q d 0, 00 Park Support Fee # $ # $
$ 38 SAC
Permit Fee $
Plan Check Fee $ • -4, 70 Water Meter Size 5/8 "; 1 ";
$ Pressure Reducer $
State Surcharge t 573/ $
Penalty $ Sewer /Water Connection Fee #
$ Water Tower Fee # $
Plumbing Permit Fee
Builder's Deposit $
Mechanical Permit Fee $ $
Sewer & Water Permit Fee $
Other
Gas Fireplace Permit Fee I $ TOTAL DUE $ (#3. Z0
J. Z I No. (y 1/ /
R ec t
This Application Becomes Your Building Permit When Approved Paid B
Date Q. /�.. //
Building Official Date
Tis mes to signed by City
issued
Planning Director
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 BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS /6f 76' U WE-31 U/eAl AVE
TYPE OF WORK D EUc_
USE OF BUILDING /Z CS /*/A
PERMIT NO. 11 . 9i Z DATE ISSUED 9. l 9'- I
BUILDER LOVE// ND PHONE# x ,55, 42 l7
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
FINAL 1 14 1 "3 - t3
FOR ALL INSPECTIONS (952) 447 - 9850