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o i PRIOR CITY OF PRIOR LAKE BUILDING PERMIT, � �..''" Date Rec'd
&' TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" AND UTILITY CONNECTION PERMIT
r
j *NES
1. � File PERMIT NO.
3. Yellow Applicant (Z _2- t
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
� ESS 1� l 21 t
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
((Na �c ..- ThQ l-k E. I .__. 4LA -.1� (\C" (Phone) q Sa - a - DZ 7
(Address) ((2 PI ( ?c, < 14i •e,,...) b S-7_-__ (- 4..(- - Le
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ['Porch ❑Re- Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: eI.R.C. DI.B.C. Misc: t�,ceDl ex.
Type of Construction: I II IQ IV V A B
Occupancy Group: A B E F III MR S U PROJECT COST /VALUE $ Z 000
Division: 1 2 3 4 5 (excluding land)
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 rev. ke • .. t for 'ust cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
�
x rL. 3 /2 / iz
Signature Contractor's License No. D ate
Permit Valuation €� .— Park Support Fee # $
Permit Fee $ 2 G- — SAC # $
Plan Check Fee $ U... ,2- , 7 r- Water Meter Size 5/8 "; 1 "; $
State Surcharge $ - S 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 $ 4 S'
Thi • • 9. li : ` j. , Becomes Your Building Permit en A ved Paid - Recei • t • a �'
� Date ., /7__ By 4 1 f.
ill ' '.� . ' Official . ' DatC
This is to fy 1 . t . request in the abottgapplication and accompanying docu , `ents is in . cordance with the City Zoning Ordinance and may proceed as requested. This document
when s• d� . e t Planner constitutes a temporary Certificate of Zoning co a.. allows construction to commence. Before occupancy, a Certificate of Occupancy must be
1 / issued .�
-" t Planning Director • a - Special Conditions, if any
4 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 l co z' ( (7412 -..- , 1' 0 Dr--
TYPE OF WORK P612-c_�,;
USE OF BUILDING p` k- (-- 1 PERMIT NO. t2-- 2 1�( DATE ISSUED 3 az
BUILDER A( rf A PHONE # q - e.41- OZ37
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
FOOTING 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
IVINVIONIa 1 1
I FINAL 1 1 .5" 15
FOR ALL INSPECTIONS (952) 447 -9850