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o PR CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
1TEMPORARY CERTIFICATE OF ZONING COMPLIANCE S z t 0
AND UTILITY CONNECTION PERMIT c . /
U g
C'A'NES; I. White File PERMIT NO .
2. Pink City 0 / /
3 Yellow Applicant ! V ll!!//
(Please type or print and sign at bottom)
ADDRESS I ZONING (office use)
I(o 3 U∎ C kb ck C„‘ „2- SE
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER '- `�
(Name) Je_ t r �/ T O....,;3 e_ (Phone)
(Address) /
BUILDER
(Company Name) ! .1 0 . s o ' St It (4.q CA • (Phone) 152 - 7 3 (- 3 3 0 p
0
(Contact Name) / 2 2 7 7 A) , ego /ice. J )-.tea. (Phot -- (,S I '2 4 1- 71 3 5
(Address) " Dm .0% Mc.Co.; 1! .•____3
TYPE OF WORK ❑ New Construction . eck ❑Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish FireptaT
DAddition ❑Alteration ❑Utility Connection
CODE: R.C. ❑I.B.C. ❑ Misc.
Type of C n struction: I II III IV V A B PROJECT COST /VALUE $ 2 Up
Occupancy Group: A B E F HI MR S U
Division: 1 2 3 4 5 (excluding land)
I hereby certify . I have furnished informati on this .plication 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 -ment • ed pr..erty and t..t all c uc - conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official ca evoke thi permit fi just c 411( o --, ,ere. . ? - e that the city official or a designee may enter upon the property to perform needed in, ections.
X . - Al //10 tag 7001 S is �t 1l D
Signature Contractor's License No. Date
Permit Valuation DOS - Park Support Fee # $
Permit Fee $ 54 . ZS SAC # $
Plan Check Fee $ 3 5 .21. Water Meter Size 5/8 "; 1 "; $
State Surcharge $ • 7 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 4nz.46-2, 0 3.1 0 $ la 2_
This i i v $ 3 /o , lica i .• ' • .. es Your Building Permit en A proved Paid (( Recei t No. 6 ( 0 2)
• 1 �/ Date 0 P —U S" 0 By 3 f'
Buil - v. Oftic . Dat
This is to certify that t request in the above application and accompanying documen is i accordance with the City Zoning Ordinance and may proceed as requested. This document
when signe- th. •,.. • anner constitutes a temporary Certificate of Zoning compl' rice d allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued v
� 13 (0
' arming Director ate 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 / (,3Z2 VIC4 - 7) //9 WeN
TYPE OF WORK
USE OF BUILDING / �2
PERMIT NO. /0. 6 1 DATE ISSUED S • Z / 6
BUILDER /4 PHONE # 73& . 33O&
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INS R DATE
FOOTING w C 1 y I
PLACE NO CONCRETE UNTIL ABOVE HAS B EN SIGNED
AMIN
I 1 I
(FINAL 1 ,� 1 ? I
FOR ALL INSPECTIONS (952) 447 - 9850
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