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PR /0 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
e TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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y, HNEscf t II. white File j Z, C
2. Pink City PERMIT NO . ^ IQ
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3 Yellow Applicant J
(Please type or print and sign at bottom)
______-- ADDRESS �/ �� � , � �� y^ � ^ fI b � lqk'
� ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER .--", �1t„i ) 9S-2 7 S ��
(Name) ie J C I to A 6 (Phone
(Address) / .. 7 , r� LCi �1r1 e L'�l ��L_
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ck EPorch ❑Re- Roofing ERe-Siding ['Lower Level Finish ❑ Fireplace
❑Addition ['Alteration ❑Utility Connection
CODE: ifgLR.C. ❑I.B.C. ❑ Misc. •
Type of Construction: 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
4. 1 hereby certify that I 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 th t all 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 can revoke this permit for ist cause Furthermore, 1 hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
� x _27
Signature Contractor's License No. Date
Permit Va ation 3 p r Park Support Fee # $
Permit Fee $ J e g .25 SAC # $
Plan Check Fee $ 51.3(0 Water Meter Size 5/8 "; 1 "; $
State Surcharge $ I. ems, Pressure Reducer $
Penalty $ 7 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 $ t4
This Ap, licati'n Becomes Your Building Pe • ' Whe Approved Paid raiti_ Recei.t N.. ���� ,__ . Date �� B �� _
.oil • se . -.. D. e
This is to cer tha the request in the above application and accompanying ocuments is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signe% t ity PI �y er constitutes a temporary Certificate of Zoni g comp ante and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued. i - q ...
k l .�t. I` k -2' l ( z_
Planning - or 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 DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS l 9 jt-t-v( Lam— TYPE OF WORK
USE OF BUILDING
PERMIT NO. l 2 - 3 \ L DATE ISSUED 4412--
BUILDER ��R -,�- �r�tar► PHONE # 44-c • 5'61,9
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECT DATE
I FOOTING I Mg i�z I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I FINAL 1 ;\' 1 . 1 ) 1
FOR ALL INSPECTIONS (952) 447 -9850