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04 Rio* CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
Et ' A ‘5;
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
ti AND UTILITY CONNECTION PERMIT
NWES/
I. white File
2. pink city PERMIT NO 1 .
Z
3. Yellow Applicant J
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
5(03 6 icd 6r_ S -C- 114 Ltliez.
LEGAL DESCRIPTION (office use only)
S r
LOT BLOC1 ADDITION G e;(1-M S C PID
OWNER q 1 103 �rts 1" 39 3
(Name) �DIZ bir (' �L -�'�'£ (Phone)
(Address) 5r1,23& 1 Z 4 E „?.o4 Lam.
BUILDER p ,�
(Company Name) MM S fK 1t O j U2- (Phone) g `7 - E' 1
-34 0 s
(Contact Name) P I \ Y''' *J Z (Phone) 11 10,- 6 1) ps a A
(Address) *tJ -r . 113' , 1 - �o NO 675
TYPE OF WORK ❑ New Construction eck ❑Porch ❑Re- Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
['Addition ❑Alter o ['Utility Connection
CODE: [LR.C. DI.B.C. ❑ Misc:
Type of Construction: I II III IV V A B �
Occupancy Group: A B E F HI MR S U PROJECT COST/VALUE $ 1 6 •00
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 revoke this perit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x- J,- -,acs 4 ti . A 5. 79. 20 /3
Signature Contractdr's License No. Date
Permit Valuation -3C f _ -- Park Support Fee # $
Permit Fee $
ge. �- SAC # $
Plan Check Fee $ 57 Water Meter Size 5/8"; 1"; $
State Surcharge $ II. .c 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 / $ (47 / f
This Appli . o • • • comes Your Building Permit Wh . Ap 1 ed Paid (41.. I Receipt No. 6,7 as
A, Date V J B 2•, /
lull. ing Official ■ ate
This is to certify, at th • . nest in the above application and accompanying docum • . - is in . • . dance with the City Zoning Ordinance and may proceed as requested. This document
when signed . . e Ci a anne constitutes a temporary Certificate of Zoning cam.. ance an. allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued. j
hIAA-i/i.Van...-_■IIIIIIIIIIb z
Planning Director .: 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
HP Photosmart 2610 Log for
Personal Printer /Fax/Copier /Scanner Kai and Nancy Hammer
952 - 492 -2695
Jan -00 -00 OO:OOAM
Last Transaction
Date Time Type Identification Duration Pages Result
Jan 00 00:OOAM Received Fax Services 1:15 2 Error 232`
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PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS Gca Sr
TYPE OF WORK {c-
USE OF BUILDING 1• - 4/fl
PERMIT NO i3 -� DATE ISS ED �5
I BUILDER /p(s fe 7 PHONE # ((° 45 `tZ
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
t. THE PERMIT IS BY SEPARATE DOCUMENT
% 2 r TD (t t` i li.1 13,4k INSPECTOR DATE
1 FOOTING W c_rb/vr(c_c�u� r' I "
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
': 1
t.
I FINAL 1 t'
FOR ALL INSPECTIONS (952) 447 -9850
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