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O ti f PRip CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd y TEMPORARY CERTIFICATE OF ZONING COMPLIANCE r/ ��, 7 AND UTILITY CONNECTION PERMIT ((f < l PERMIT NO 'IjNN E gOge' I. White rile
2. Pink City i L. 7 �' 56, el,
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS
t► ) / /� 1 1::::,—' ZONING (office use)
1 'T Z t S V 1 i ! V ! cam( La KKK 5(",s.---I L
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID ZS _ O 4 vW :O
OWNER 1. E' ,IY> cX ✓'� C 0 ('
(Name) pE'� (Phone) t2 f " 2 - 2 _ i 9 L /
(Address)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
v.
TYPE OF WORK ❑ New Construction eck ❑Porch ['Re-Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alte io ['Utility Connection
CODE: LR.C. ❑LB.C.
El Misc.
Type of onstruction: I II III IV V AB PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
1 hereby certify that 1 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 ha 11 construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official c evoke this permi 4 cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform necdc inspections.
X 1 X 1"1- — 7 — f 2—
Signature Contractor's License No. Date
Permit Valuation Z ` 0 00 .00 Park Support Fee # $
Permit Fee $ 73 , •-75 SAC # $
Plan Check Fee $ �/ q ' Water Meter Size 5/8 "; 1 "; $
State Surcharge $ (.. 0 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 (4u) C73 6 1 I 1 $ I2 Z ,_ (
This plic, "i n Becomes You Building Permit Whe Appro ed P aid Z Z �•G i No. U! 1a t/ _
e � / (Z Date C ote b ' I L —
:uildin_ 3icial .te
This is to ertify h the request in the above application and accompanying document s in ac rdance with the City Zoning Ordinance and may proceed as requested. This document
when s ,nc by , h City Planner constitutes a temporary Certificate of Zoning compli cc an (lows construction to commence. Before occupancy, a Certificate of Occupancy must be
issu ,
ilk
Pla t . • a' - • Da 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 1+211 RStfCream Ave.
TYPE OF WORK •
USE OF BUILDING A` ,
PERMIT NO. j DATE ISSUED 4. 15.
BUILDER LE A, PHONE # OZ. .169
I9
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR n TE
I FOOTING � � I � (
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SI NED
I 1
I FINAL I I 1. 1 _
FOR ALL INSPECTIONS (952) 447 -9850