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o ,i PR / CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
1 \
r TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
J AND UTILITY CONNECTION PERMIT
1-/Le` - 464 2
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M'4'NES.�P I. White File
2. Pink city PERMIT NO. 6.,--5
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
(7 ( 78 .T0A- e S , k.)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER / S� 'j y �Q 8 � +
(Name) h,�'� -"� � , i (Phone)
(Address) 6g1¢
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction eck ['Porch ❑Re- Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
['Addition ❑Altera on ❑Utility Connection
CODE: R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V AB PROJECT COST /VALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I 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 I am the owner or authonzed agent for the
above - mentioned property and that 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 rev ermit for just caus Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed ins ctions. / oa
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ zo z SAC # $
Plan Check Fee $ c1:30 Water Meter Size 5/8 "; 1 "; $
State Surcharge $ / . .50 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 $ (41.1 (
j / /de' / 1
This Applicat ; e , • s Your Building Permit When Approved Paid / 7 �/ � � 1 R eipt No. �-4 J
/ 4 Date b, 2C. U,r y _ • .Ait,--_,./111P e A /41
It uildine •tticial Date
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 Prior Lake, MN 55372
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Disclaimer.: This information is to be used for reference purposes only. Scott County does
not guarantee accuracy of the material contained herein and is not responsible for misuse
or misinterpretation. Surveyor information is updated daily and the data for this application
is updated weekly. For current information contact the Scott County Surveyors Office. The Map Scale
preceding disclaimer is provided pursuant to Minnesota Statutes §466.03, Subd. 21 1 inch— 36 feet
(2000), and the user of this map acknowledges that the County shall not be liable for any
damages, and expressly waives all claims, and agrees to defend, indemnify, and holdAppRO\T
harmless the County from any and all claims brought by User, its employees or age,�Ls��CT
third parties which arise out of the user's access or use of data provided. tt''LL
iigned� Date
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Disclaimer: This information is to be used for reference purposes only. Scott County does
not guarantee accuracy of the material contained herein and is not responsible for misuse
or misinterpretation. Surveyor information is updated daily and the data for this application
is updated weekly. For current information contact the Scott County Surveyors Office. The Map Scale
preceding disclaimer is provided pursuant to Minnesota Statutes §466.03, Subd. 21 1 inch = 36 feet
(2000), and the user of this map acknowledges that the County shall not be liable for any
damages, and expressly waives all claims, and agrees to defend, indemnify, and hold
harmless the County from any and all claims brought by User, its employees or agents, or
third parties which arise out of the user's access or use of data provided.
http: / /gis.co. scott. mn. us / ScottGIS /printPreview.aspx ?PrintOptData =17178 Ida Circlel0l0Itruelfalself... 7/9/2008
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS 171 79 I f elect( S41
TYPE OF WORK ABOVE 6,44400 RM.,
USE OF BUILDING S• PD •
PERMIT NO. et " &It DATE ISSUED ? jI to,
BUILDER LE6SJA PHONE #'jsZ • -`8
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
7VCTOR TE
FOOT! N G MACE. r 1 IiD
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN IGNED
1 FRAMING S Ti AA,/ �,�,1"
, '� 1 put 4i Adt.
isms FINAL PT -
excr Fh �
FOR ALL INSPECTIONS (952) 447 - 9850