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0 O PRi CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
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TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 4 3 3 t.,
Z.) A 1 UTILITY C • NECTION PERMIT
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41 1 I. Whim File
2. Pink City PERMIT NO. 13 _z45
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
J .5 3 e,C' 8i'eezr eo i , -7(r - Rd . P--(
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID 25.02.1o. U08 O
OWNS
(Name) t1 /1 . Sl e 4 1' a r7. F :' n f a (Phone)
(Address) /. ,3 ® , a r e e e Z.r (0 d i 4t t' /cI
BUILDER �p 1 ■
(Company Name) /\ ( e c Ic 6 e 5 T , a/ i a /72 (Phone) [ - A e l e / 2- 7 7 ry
(Contact Name) Lae e a( i i r G ilk (Phone) f,2 - 7 8Ce ' / J5
(Address) 5 k 1 W< It o 2J L5' et c 3 r „5-7,' 60, P'" 0 y La. A I'f J' d i' j' 7
TYPE OF WORK 0 New Construction 136eck DPorch DRe- Roofing DRe- Siding ❑Lower Level Finish 0 Fireplace
/ ❑Addition DAlteration DUtility Connection
CODE: QT.R.C. DLB.C. 0 Misc.
Type of Construction: I II III IV V AB PROJECT COST /VALUE $ /6, ®O°. 00
Occupancy Group: A B E F HI MR S U (excluding land) z
Division: 1 2 3 4 5 1
I hereby certify that I have punished 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 this permit for just caus Furthermore I hereby agree that the city official or a designee may enter upon the property to perform needed rasp tons.
1 / /3 d Z 12. 6 4- 3
1 X _ ��
S Contractor's License No. Date
-
Permit Valuatio 20 I Z w .f.7,e,',% _ Park Support Fee # $
Permit Fee $ U-I -14. SAC # $
Plan Check Fee $ itip � Water Meter Size 5/8 "; I"; $
State Surcharge $ Z .50 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 1 $ TOTAL DUE $ (C1(
CA', 1-1-6 IRO
This Application :ecomiYo ■ Building Permit en proved .1 aid / r Z r R No.
/ i . /' 0 l D ate i �, `�q By s-A3
.� r - 'i or_ 4' 9- 13 "[ [
Building Official D. e
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 Pla er co. sst , to ., temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Cc7titicate of Occupancy must be
issued
Pi. ning Djt' tor Date Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372
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White - Building
yl �P Canary - Engineering
^'NES° Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT /(21C1... , /-; ft )f ,'6 �°✓'
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APPLICATION RECEIVED `
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
Accepted Accepted With Corrections
Denied
Reviewed By: L / ,`` Date:
y //
Comments:
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
r
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS
S
TYPE OF WORK T) ee K ■1' \J 4
USE OF BUILDING
PERMIT NO. / DATE ISSUED 4 14/45
BUILDER f ' i zc,K �0a /uc PHONE # afz ZSZ - 7
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
*BMW 1 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I FRAMING
I FINAL 1 1 1
FOR ALL INSPECTIONS (952) 447 - 9850