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° 1 ' ... i p CITY OF PRIOR LAKE BUILDING PERMIT Date Rec'd
v 1 , TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
„,
AND UTILITY CONNECTION PERMIT ?moo '
jr iNN asOS P.
I. white City 2 Pink City I I PERMIT NO . 13 Z--7
.
3. Yellow Applicant
(Please type or print and sign at bottom) °D
ADDRESS
��5 I / D
�Y 'l �O ��r/ G� ZONING (office use)
C Alit/
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER t
(Name) Pa 71 f- 6ar7Y 1.0/ MS (Phone)
Y Sol 7�� -G54!
(Address) 14 545,1 i b ch 1Ji'/ d rZ Cpz- . y4
BUILDER .
(Name) s Q 1 'Q P) /9 r C - s rn /lp fili° S (Phone) as/ 1' 7 ^ AS 7
(Contact Name) /Qo // // Q /7
4! (Phone) 411191 ` 6/•. • y!y- OS b 2-
(Address) . 8•3 (o/n] Iri'114 n IJJ 8 T m n • S57 2 7 - 71 75
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re -Roofm
g ❑Re- Siding
❑Lower Level Finish ❑ Fireplace ❑Addition
Alteration ❑Utility Connection
M Misc. 4 el di ) a PROJECT COST /VALUE (excluding land) $ 6 . v
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. m aw e tha / . e building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
enter upon/ .. t -rty rfo ne- iedinspections.
X a � .�� I e'.0 ec 59 /ysS) ),..7A/70/
Signature Contractor's License No. Date
Permit Valuation
0000. OC, Park Support Fee t# $
Permit Fee $ i 1 1 * h 5 SAC # $
Plan Check Fee $ . P1 ‘. 5 4f Water Meter Size 5/8 "; 1"; $
State Surcharge $ 2 .5-0 Pressure Reducer $
Penalty $ City SAC and WAC # $
Plumbing Permit Fee $ Water Tower Fee ## $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other , • $ _
Gas Fireplace Permit Fee $ TOTAL DUE $ J94 -7y.
/ 6 / '
T • ' • .•;�� , o Bees Your Building Permit When Approved Paid /9 cf.. 6 • 7'1 Z eipt No. /
J
Buildi • •fficial 81( ' Date Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447 - 9850, fax (952) 447
16200 Eagle Creek Avenue Prior Lake, MN 55372
PRIOR LAKE BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS 1 (4{5 I .1(NO(IRcQcbA O.F'
TYPE OF WORK 9rr� n 10.
USE OF BUILDING u
PERMIT NO. 1_5 n L J DATE ISSUED 1 7/3h
BUILDER Sav4s�h: Cns4on PHONE GS /- 4 / 0 7 - 457/
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FOOTING 1 f /-
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
j FINAL 1 /./
FOR ALL INSPECTIONS (952) 447 -9850