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e i f PRJO CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd g TEMPORARY CERTIFICATE OF ZONING COMPLIANCE � / AND UTILITY CONNECTION PERMIT
bLJvi � I White File PERMIT NO . 9.. i 7 ,
2 Pink City 7
3 Yellow Applicant /`
(Please type or print and sign at bottom)
ADDRESS 1 ZONING (office use)
1 ®52 Iii
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) Al Ha. rive- �' (Phone)
(Address)
BUILDER 1 'LA J A ) 05 2) 7 ? to ' ? (Corn an Name) �l � C�� !� � A - (Phone)
(Contact Name) i6 c w ile ) vr►"t (Phone)
(Address) l 22 Pf Loati- f t A ° S ` , 6,wi kl ift4IJ 55 33 7 •
TYPE OF WORK ❑ New Construction ( ❑Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish E] Fireplace
❑Addition ❑Alter ['Utility Connection
CODE: CI I.R.C. ❑I.B.C. ❑ Misc.
•
Type of Construction: I II III IV V A B PROJECT COST /VALUE $ L I/ 000
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
1 hereby certify that I have furnished in ormation on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above - mentioned pr ty and t a , onstru will conform to all existing state and local laws 865 .700 will proceed in accordance with submitted plans. I am aware that the building
3rr' / �' Y agree city 86 J g - 7 V 0 t 5 property perform 1 i Z
official c r permit r C � trthermore, I hereb a ree that the ct official or a designee may enter upon the roP e to erform needed nspccti i
l�l, Z
Signature Contractor's License No. Date
Permit Valuation 5000 Park Support Fee # $
Permit Fee $ (1/-15- SAC # $
Plan Check Fee $ 1 (0. ', Water Meter Size 5/8 "; 1 "; $
State Surcharge $ . , Co Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other ��� � n $
Gas Fireplace Permit Fee $ TOTAL DUE C l:!/ 2 q $ 1 110.1
This . pl ion Becomes Your Building Pe ' When proved ,Paid 1/4. / 9 Receipt_ . . I ■ � 2- Date 9�/ f�/ .2.— By
1 ,
r dine Official D to
This is to certify at the request in the above application and accompanying doct ents ' in accordance with the City Zoning Ordinance and may proceed as requested. This document
when si_ . i b e City Flannel constitutes a temporary Certificate of Zoning c plia c and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued
i, .4 /M1 ...cent
7 � ..Z—
' Planning Dir 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 BUPLDRNG AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS I5052. /'inN/ mu leO.
TYPE OF WORK D �L
USE OF BUILDING tF' 4/f&
PERMIT NO. /Z • iO ? 7 DATE ISSUED . /¢'• /z-
BUILDER 111.--L SF.L �,�?SO/VS ,31.Z q. PHO E # gSL. 73(¢. SOS
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR M
I FOOTING - {h I (/� I 4�
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ENO 1 1
I FINAL I (1, 1
FOR ALL INSPECTIONS (952) 447 - 9850