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0 1 PRIN CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
4. ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 5 2.1., 13
AND UTILITY CONNECTION PERMIT
~Z WNESOs. I. White File
2. in city PERMIT NO. /3 , 4.6r
3 Yellow Applicant `
(Please type or print and sign at bottom) _
ADDRESS ZONING (office use)
3 /'; Point a.,s9 M
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID 'r5. 41 • 0( , Q
OWNER , x
(Name) rk:A,1et 1 iet,A.. \G (Phone) / J ��' 3
J 2- 't r Phone
)
(Address) 3 75 ;� ho iV4 ( i-G'.55 p rior o t' 1 � i � v i, f 5 -. 5 - 5 �.,z-
1
BUILDER ..
(Company Name) /Z) L ')t.Terit, s Ia ,Y cxe i.N,-.. (Phone) 76- 3 - 4238 .- t7. .33 --`3
(Contact Name) , 14y it /w�^i rr,5 (Phone)
(Address) P U t.X''N CO 0.5_5 - �& Aj � ' 5-5-
5 -. i
TYPE OF WORK ❑ New Construction Deck ❑Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: R. C. ❑I.B.C. ❑ Misc.
Type of o truction: I II III IV V A B
Occupancy Group: A B E F H I M R S U fv . ''��
PROJECT COST /VALUE $ 7 7
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• .. t ' ; rmit for lust cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed ins ections-
Signature Contractor's License No. Date
Permit Valuation 3 0 0 0 0 Park Support Fee # $
Permit Fee $ go as ' SAC # $
Plan Check Fee $ 6-7. 3 eo Water Meter Size 5/8 "; 1 "; $
State Surcharge $ / S - 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 12,4? $
u Gas Fireplace Permit Fee $ TOTAL DUE aC $ / 4-7. //
This A , ; ica ' n Becomes Your Building Perini en pproved Paid /4 / ( ceipt No. tC2 9/
d iit.,..___■. :.,,,
/ Date ( 6 , /7 y
• `r ing Official to
This is to c t ify t the request in the above application and accompanying do' ments i n accordance with the City Zoning Ordinance and may proceed as requested. This document
when sig i t by City Planner cottsntutes a temporary Certificate of Zonin- ompliam • and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Date Special Conditions, if any
24 hour notice for all inspections (952) 447 - 985(1, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372
•
PRIOR LAKE BUILD IN DOF
INSPECTION
INSPECTION
RECORD
SITE ADDRESS 375Z p!N7E LASS
TYPE OF WORK Dead-
USE OF BUILDING IZE � /r•
PERMIT NO. 13. � DATE ISSUED 21.13
BUILDER EP/ d. � T S. �/UO�+ PHONE # 743. =ft. Oa
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
FOOTING 1 � l � -i-� ,3 I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I FINAL 1
FOR ALL INSPECTIONS (952) 447 -9850