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pR � CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,
\ \ ' '7 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
"� <'........._ ...._ _,,,, AND UTILITY C ONNECTION PERMIT S' Z 4.. e� fa
I. white File PERMIT NO . / /
2. Pink City /
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS 8 37 36 Po A-I fc. Pct SS w ZONING (office use)
RA,,V` LG (ec , ktA) SS37
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID 25..4-7c/ . 010. C)
OWNER II J ] // f e2.-- //�� '' ll
(Name) � ✓7 CI .J 'ti- 1h e l � I/ cli w a ? C hone � S '1 9 ' � V q
,
(Address) 37 3(o Po ,\,i 1 s Pte, S cC)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction %Deck ❑Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
DAddition ❑Alteration DUtility Connection
CODE: ❑I.R.C. ❑LB.C. ❑ Misc:
Type of Construction: I 11 III IV V A B
Occupancy Group: A B E F H I M R 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 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 revok- this permit or: st cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X 1_ i - y
Signatures Contractor's License No. Date J
Permit Valuation Park Support Fee # $
Permit Fee $ �)� SAC # $
Plan Check Fee $ 6 6 . 'ITS- Water Meter Size 5/8 "; 1 "; $
State Surcharge $ 0 y 0 0 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 7 , , Cj t 5
This Appli i :. Comes Your Building Permit ten Apt oved Paid / 7 /, R ipt No. 6 ! 0 7 0 _ r Date . ; Z- /
OW n.Officio ` 1 " Date
This is to certi . t th r quest in the above application and accompanying documents is n accord. ' ce with the City Zoning Ordinance and may proceed as requested. This document
when signed b i ' anner constitutes a temporary Certificate of Zoning complian and allow- construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
�t 47 4
Planni - D irector D.te 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 BUILDING D�INSPECTION
INSPECTION
RECORD
SITE ADDRESS 373E PofNa Ii435
TYPE OF WORK DECA4
USE OF BUILDING RES /
PERMIT NO. /3,416/ DATE ISSUED S, 2¢. /3
BUILDER Serni/IMe DT PHONE 11 923. ZL.
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DATE I FOOTING kJc 1 P1> 6/5/r5 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I FINAL 1 /4 I Ad; 7/24 /(1/47
FOR ALL INSPECTIONS (952) 447 -9850