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o f PRi o� P CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
4, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
7, AND UTILITY CONNECTION PERMIT
4'ip „ I. White File
2 Pink City PERMIT NO . i3 3/L
fO
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
? ‘39 /4/4e4V\ ii 9 A ,
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER {
(Name) ,i 1 . a 4 Pa
h k_ c - 0 (Phone) in- • 4 fl • 0 5 - U
(Address) ,...3q1-7 /4 dh,,,n /,C LF',n .1L,,:
BUILDER
(Company Name) ��L
s� (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction teDeck ❑Porch DRe- Roofing ORe- Siding ❑Lower Level Finish 0 Fireplace
❑Addition DAlteration ❑Utility Connection
CODE: I.R.C. DI.B.C. 0 Misc.
Type of Colnstruction: I II III IV V AB PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U
(excluding land)
Division: I 2 3 4 5
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. 1 am aware that the building
official can rev t rmit f rust caused utthermore. I reby agree that the city official or a designee may enter upon the property to perform needed inspections.
X L X c s
L —....-1 Signature Contractor's License No. Date
Permit Valuation $ 60 , — Park Support Fee # $
Permit Fee $ 3 4-.15 SAC # $
Plan Check Fee $ Z 2 .51 Water Meter Size 5/8 "; 1"; $
State Surcharge $ S, 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 $ 5' J S f
This A� ∎ lica • t Becomes Your Building Permit n Ap , oved Paid 5 .� f Receipt No. 4. SC, 3t5' / / (, ! 3 • Date 4 By 6
• 13t ildino - ” is P ate
This is to certi that the r quest in the above application and accompanying docum nts is in ccordance with the City Zoning Ordinance and may proceed as requested. This document
.
when signed � n Ci lann r constitutes a tepporary Certificate of Zoning com.fiance . d allows construction to commence. Before occupancy, a Certdcate of Occupancy must be
issued / -....
r
Planning Director _ Da e 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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PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECOFD
SITE ADDRESS 3144 l < c 6 3 .®"� T�.A -«-
TYPE OF WORK
USE OF BUILDING tom - S A- / --
PERMIT NO.
• 3(& DATE ISSUED it
BUILDER Vtt FA Pr'i L b r PHONE # ?/o
, NOTE: THIS IS NOT A . PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
PECTOR DATE
FOOTING 5 C /V /.
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN S GNED
I FRAMING M 1 (e _21 13
I FINAL A I
FOR ALL INSPECTIONS (952) 447 -9850
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