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0 - -- �4, CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
.. 9 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
7 `� AND UTILITY CONNECTION PERMIT 4 / 0
r ` W E5 °�
I. White File PERMIT NO . z 2. Perak City 1� 7 7
(Please 3. Yellow Applicant
( type or print and sign at bottom)
ADDRESS ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) )hcvy .E , 00,, Ulr''S (Phone) 6 / - 4/3� -- D Q41 7
(Address)
BUILDER • ?` c ,- S' ' a O_
(Company Name) DQ.c.K.S (M,t\,1 B'-, / (Phone) I, 1
(Contact Name) Qs,,r.041 Ai, 0-e_.. (Phone) 7 ( ' 2Y2- O3/Y
(Address) S 'o 30a s e- (70 a-0 M.tt s -- s - 1
TYPE OF WORK New Construction Deck ❑Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
['Addition ['Alteration ❑Utility Connection
CODE. I.R.C. I.B.C. ❑ Misc:
Type of onstruction: I II III IV V A B ,
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $ :� C ) O
Division: 1 2 3 4 5 (excluding land) L t
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 authorized 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 r ke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X ) gc- 6acl )55 4 - 9--43
Signature Contractor's License No. Date
Permit Valuation ' i Park Support Fee # $
Permit Fee $ ZS SAC # $
Plan Check Fee $ 51. . 7-
Water Meter Size 5/8 "; 1 "; $
State Surcharge $ ( ,. U 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 $ 14)--1 / 1
This Appli ton : eco % Y t ■ Building Permit Whe Ai). oved Paid !��� Recei et � � _ f•��
,,,t ' 0f`r 4 3 Da B
: uildin • Official - .
This is to . d that • e • - quest in the above application and accompanying do ment• is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when sign: . e C 'tier constitutes a temporary Certificate of Zoning • .. p ce and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
•
issued. /
, t,ai 4 • r
7.7511J
or 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 / (' '
TYPE OF WORK PCelt-
USE OF BUILDING i2e` x
PERMIT NO. / 3 . DATE ISSUED 4 - y ` - 7 3
BUILDER D PHONE # cot 2 - . / _ 0S0
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FOOTING 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I
FINAL I' y
FOR ALL INSPECTIONS (952) 447 -9850