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� Pith., CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
4'kN ESOir I. white File PERMIT NO
3 pink City t ' 3 - (iw ,.�
3 Yellow Applicant ' Z 1
(Please type or print and sign at bottom)
ADDRESS // /� ZONING (office use)
` 7 5L1 / 0[4 Rel S
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER ki4 b. r "
(Name) e r -e /'ri -e- (Phone) C l 2 • & 3 4. 3 4"G Z
(Address) 1 S C 76 . F. 54 PO ; <1 R d S
BUILDER n
(Company Name) J 4 1- 14 it) -To N w "0 iv CUPI 51`/' c, rr c1 /
..n L1 (Phone)
(Contact Name) Cl /ate T0/7E/ifs(' in (Phone) 7C3 -- 2 V 2 °1S9s2
P; (Address) 22 S /� --/-e V € e IA— LA /. Pf MC LP, 1/11 rl SS SfY (
TYPE OF WORK ❑ New Construction ,QDeck ❑Porch ❑Re- Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
DAddition DAlteration DUtility Connection
CODE: 6.R.C. ❑I.B.C. ❑ Misc. o
Type of Construction: I II III IV V A B PROJECT COST /VALUE $ 7 `5 7s so • 6
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
1 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 1 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 c oke this perm t for j t cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X 4 1 A c- Ss9/ 70 6 /, 9//3
Signature Contractor's License No. Date
Permit Valuation
it' Park Support Fee # $
Permit Fee $ `"1 (03_ - SAC # $
Plan Check Fee $ . r 5 Water Meter Size 5/8 "; 1 "; $
State Surcharge $ Z - — 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 $ 11 1 lS
This lic.tion:eco sYourBulldingPermitWh Ap rued Paid ���� Recei.tNo. 'Ajl
ILA Date '. B 4IA_ •
� y� /� t ��
Bail " ticial Uate
This is to ce1rfy that th • •ue.• in the above application and accompanying docu °nts is in +ccordance with the City Zoning Ordinance and may proceed as requested. This document
when sign , , by th • Cif an r constituan a temporary Certificate of Zoning co .liance a d allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
4 111 r f
Plann''A ector l a • Special Conditions, if any
--"" 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 (S7( ( =k5k. �vr PIO
TYPE OF WORK �-(4-
USE OF BUILDING l A"�(
PERMIT NO f 3 -aZ9 DATE ISSUED (° 7(1 A
V BUILDER ��,4r-�' � of+ni S�J ^feex/5�2• PHONE# 2( 7 -4Z - f ccr2
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
( - 1---- INSPECTOR DATE
FOOTING I 1 'I- ! "1" +:f
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
� i 41"130Z" 1 1 I
, FINAL �_
FOR ALL INSPECTIONS (952) 447 -9850