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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
E'r TEMPORARY CERTIFICATE OF ZONING COMPLIANCE g _ / Z
u rr AND UTILITY CONNECTION PERMIT
.2 ; ;�e-
NA /ESA
1. white File
2 Pink City PERMIT NO. /z 7
0
.
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/ 272 Fa;r(,)61 / »hI5 DC!
LEGAL DESCRIPTION (office use only)
LOT 1 3 BLOCK .2 ADDITION 1,3 e n5 t'At,∎ \ /\ , s l- PM
OWNER 0°3 (Phone b 12 -7 / 0 - 5 [ 9 U
(Name) � G � . � C' �%� �� J I 1
(Address) 15 27 2 /G7 if ii)C�y '4eI � l'h i s k OCx
BU
(Co IIDER I/„ ) 6l 2- - 7`70j tic 0
(Company Name) G � ? � U t.�� � (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction INDeck ['Porch EIRe-Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
['Addition ❑Alteration ['Utility Connection
CODE: [I§I.R.C. DIX .C. ❑ Misc:
Type of Construction: I If III IV V A B r ,
Occupancy Group: A B E F II I M R S U PROJECT COST /VALUE $ 7 000
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 revoke tl spermit for just cause. Fu ermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
... Signature Contractor's License No. Date
Permit Valuation -- Park Support Fee # $
Permit Fee $ (l ,' SAC # $
Plan Check Fee $ lb-5-4- Water Meter Size 5/8 "; 1 "; $
State Surcharge $ .L` J 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 ( 1'1 1 'i V I ij ` ' $ k Cj C , `ZCi
This ' 4ica sn : • • owes Your Building Permit Wile Appr ed Paid / 4 74'. 7 / Re e}pt No. ( 96 , 1)19
//(( Date , !y • `2-- B
�� ,Ii- - c • r4- (' 'Z- .
Buildin= official ate 1
This is to c- that the re-,' , .t in the above application and accompanying docu o nts is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when sip the w ty :or: / er constitutes a temporary Certificate of Zoning co pliancy and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued. / /,y
k .1 1 At AL Al 40 lrg rz
URt _ Director Date 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 I 5 27L 1 «. MM1/
TYPE OF WORK DEC.0
USE OF BUILDING £r4 X/
PERMIT NO. /1. ' / / DATE ISSUED 8. 13./2.
BUILDER D.S* / • 1 PHONE # ba.. % ,54
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR t DATE
I FOOTING -2 1 'fa t
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I ISOMialt. 1
IFINAL 1 4, 1 14
FOR ALL INSPECTIONS (952) 447 -9850