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,� �� pltlO4 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
t AND UTILITY CONNECTION PERMIT 1. Z'/ Z
' N ES°� - 7- 213
I. white File
2. Pink City PERMIT NO . /z. .. z35
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
�'-3eg e 7,- ,..j L N SL e/
LEGAL DESCRIPTION (office use only)
LOT / BLOCK 3 ADDITION 63 il/ � ' C ,f1'x'7 PID Z5. 455q-. 0 2,3, 0
OWNER P Roo K (Phone) gs 2 270 - 19 7 7
(Address) -s3 t9$ 7r€../A L / V S e
BUILDER
(Company Name) (Phone)
(Contact Name) P - I ` - o oK (Phone) q5 270- ?I/ 7
(Address) 3 e. r<e ill , 4,4 o vC
TYPE OF WORK 0 New Construction 1Deck DPorch DRe- Roofing DRe- Siding ['Lower Level Finish 0 Fireplace
DAddition DAlteration DUtility Connection
CODE: I.R.C. I.B.C. 0 Misc:
Type of Construction: I II III IV V A B ��. ^ j0
Occupancy Group: A BE F HI MR S U PROJECT COST /VALUE $ ,
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 c' vo. . is permit jus se. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X .Q.% . ``I/ l/ II—
' / ignature Contractor's License No. Date
Permit Valuation ,, — Park Support Fee # $
Permit Fee $ 1 0 r —. SAC # $
Plan Check Fee $ - 1`7 Water Meter Size 5/8"; 1"; $
State Surcharge $ y 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 di, 3 /2- $ 11 I e f 5
This � Becomes Your Building Permit , . . Approved Paid /7 / (75 R ipt No. 6, 3_57 /
A
" Date ¢ ., 1 /2--
:timin . • Date
This is to,. "rtify the request in the above application and accompanying docume, N is accordance with the City Zoning Ordinance and may proceed as requested. This document
when s / by S City • anner consti temporary Certificate of Zoning com. . c and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued t '
Plani T; - . 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 OF DEPATMENT OF
PRIOR AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS 53 8 g 11 VN9\13
TYPE OF WORK
USE OF BUILDING RCS ft'IZ.
PERMIT NO. 17- . Z3 DATE ISSUED ` F' - `F'
BUILDER R-00 K., PHONE it yl a _ 0917
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR / FOOTING wc- 1 Oh � � I
PLACE NO CONCRETE UNTIL ABOVE HA BEEN SIGNED
istamms 1 1
(FINAL 1 Al S +7
FOR ALL INSPECTIONS (952) 447 - 9850
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