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ti o -• * CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
4.,,,,,. _.0
kivEso x TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
`� AND UTILITY CONNECTION PERMIT `� - . 1 1 1 Z
1. White File
2. Pink PERMIT NO .
nk City Jj
3. Yellow Applicant 1 Z r e� ��
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
Ili 024 8kg b; td r t & j o E , OW "? 2
Pe �Nor Lct I
LEGAL DESCRIPTION (office use only)
LOT f BLOCK' ADDITION k CT- 11 2 t ckddi14,9 Ili PID 2,5 ` 3
(Naam /4 e_ 14 [ _l P 144 k. (Phone 0, v)) 21)y
(Address) ) `1 C22b 81 14 5,0 I ro„1 1 ikik PNar Lsl / L kiv 6 Z
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction Deck Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ['Alteration DUtility Connection
CODE: DI.R.C. ❑I.B.C. ❑ Misc:
Type of Construction: I II III IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COST /VALUE $ :36,00
Division: 1 2 3 4 5 (excluding land)
I hereby certi that I have furnished in ormation on thi pplication 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- menti." ed p operty and that ., construction w' conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official c. r + voke is . erm s a e. F erm. e, I her -by agree that the city official or a designee may enter upon the property to perform needed inspections.
x I��t l i l .i
Signat f w Contractor's License No. Date
Permit Valuation / ( 1, C . C c. Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ 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 $
r
This Application Becomes Your Building Permit When Approved Paid t� '.) 6'' Re ipt No. (4" 'j "(,; / .! !
Date r,j ./3 ,L
Building Official Date , t
I
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS ' - /E2$/ — f
TYPE OF WORK =`=
USE OF BUILDING s '
PERMIT NO. - DATE ISSUED �, r . e z--
BUILDER '' ,r- r/; PHONE # f. 77c"
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
IN PECTOR DATE
I FOOTING c 1P6 S /1> 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
1 FINAL 1 Q0 6h/hi
FOR ALL INSPECTIONS (952) 447 -9850