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0 CITY OF PRIOR LAKE BUILDING PERMIT, . Date Recd
,, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
U �j
*INNESO I White File PERMIT NO Pink City I�2
3
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
3755 Is/ A-96 v/E .J d/ cr_E N.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) O < 57 - E./ Da. L, ( P h o n e ) 6 1 Z , 3 z — 5517
(Address) 373 .1 5/.47ab V /EIA) dher?' Ai. •t 0 .
BUILDER 1
(Company Name) /1i, E77Y/lf l ( ASS C-, (Phone) (Z) 407 S7Z4C)
(Contact Name) * F r P E Y f (Phone) 052) 600 '87ZO
(Address) 127 C ,ev &) A-v/E . S4 J,}E. . J 41/.1 . 553715
TYPE OF WORK ❑ New Construction Deck ['Porch ❑Re- Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
['Addition DAlteration ['Utility Connection
CODE: EII.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V AB PROJECT COST /VALUE $ _ Zej OOp
Occupancy Group: A B E F HI MR 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 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. 1 am aware that the building
official can , �� e fit. ■ rmit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
an
x 21 fig 13 t/ S°-7 -201 Z
Signature Contractor's License No. Date
Permit Valuation S Park Support Fee # $
Permit Fee $ 1 1' SAC # $
Plan Check Fee $ It) - 74- Water Meter Size 5/8 "; 1 "; $
State Surcharge $ -Z, co 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 sj F - j' C./ z.- Co $ 1 1 1/
This •, io ' ,'•
co es Your Boe Whe Appr,ved Paid / 9t/. if R No. 66.//3
. i ,{�� Date 5- Z Z � 2, By
� -t r"1
Buil , a ate
This is to c •. that the r .' est n the above application and accompanying docum is is i accordance with the City Zoning Ordinance and may proceed as requested. This document
when sign t the ty ne constitutes a temporary Certificate of Zoning corn lance d allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued. /
P anm - _ Dat 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 S q■L r
TYPE OF WORK �,,�_��
USE OF BUILDING F A
PERMIT NO. (-L , 4 DATE ISSUE :r' i4
BUILDER A',,:e r a , iiO4E`P i,. PHONE # `° 2- C - .b72,=
NOTE: THIS IS NOT A PER T FOR ANY OF THE INSPECTIONS BELOW
THE PERMITR BY S PARATE DOCUMENT
G ■ I I, J 62 INSPECTOR DfiTE
I FOOTING ,1 // , rZ. 41
PLACE NO CONCRETE U IL ABOVE HAS BEEN SIGNED
I FRAMING 1 1
I FINAL 1 1 ' -
FOR ALL INSPECTIONS (952) 447 -9850