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Building Permit 12. 0884 (2)
0 O 0000 - 0 a E OK 7 . / 0 0 O c X 1111 0 t 0 § � ® 0 E. c 22 m m m n o 73 cn \ m m \ �\ C� \§kk § 0 73 k © q L B a z 3 , CO § z 2 § IQ n _ a \ \ g \ j n x "n 0> 0 • • C -1-- r 1 m m h o r z f 7 \ RI -n 13 ) 2 0 0 J— ' 000000 } m § q m � *c) "Ti x m m , jc -I nc 2 ® E ° ° ,---- ■ 0 _§ mI§ o @ \ { M / \ � >°oo 3 0 m M , � - r -n o0 § = P c % z \ z — I \§ § m c g s § r o \ k o p O I 1 0 % 2 0 0000 m tr;41 § 2 ' ' (nmm § R. k O m���0 x.,,,,, % 0 /, �, �gmk7 1 73 -n » § 2 III 0> z m ®' - . ® r 0 of P141-0 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd TEMPORARY CERTIFICATE OF ZONING COMPLIANCE AND UTILITY CONNECTION PERMIT Pe MY y 4'�N,vesotr a White � y PERMIT NO./ .130 a Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office usoo 375 S 1 u4--ALb J / E t4 d',ec r_. F. N • tkif • , LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER • (Name) Lt-O ' S i DE.-_t____ (Phone 6 fZ) 3 i - 5517 (Address) 375 SL ?)b V if J dherzL E, At 1.0 BUILDER .1 / (Company Name) �f, 7 1 A5sc - r, , ) -<-�C (Phone) C95Z, {007 - 871.4) (Contact Name) fihrir PeE7T Y0/471/4/ (Phone) 05Z 407 - g7ZD (Address) 1274k) ('P.FEiIi ) 4 . S4 JA-F 41A/ . .55376 TYPE OF WORK ❑ New Construction %Deck DPorch ❑Re Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace ❑Addition ❑Alteration ❑Utility Connection CODE: 2I.R.C. ❑I.B.C. ❑ Misc. Type of Construction: I II III IV V AB PROJECT COST /VALUE $ _ 7-C) OOp Occupancy Group: A B E F HI MR S U (excluding land) Division: 1 2 3 4 5 1 hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. 1 also certify that I am the owner or authorized agent for the above - mentioned pro crty 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 r el . rmit for just cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections. X can, fei3 tO a -201 z Signature Contractor's License No. Date Permit Valuation — Park Support Fee # $ Permit Fee $ SAC # $ Plan Check Fee $ 10 . 5-4- Water Meter Size 5/8 "; 1 "; $ State Surcharge $ L. Co 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 DUES F _ i 5:11.--- $ l l 10 . 11 This / hc. o co es Your Permit Whe Appr.ved Paid / 76- if R No. 6 6 //� / _ Date :. Z Z �/'L By • / Buil 2 0 IC ial s ate This 0 to cthat t c r .' est - n the above application and accompanying docum is is i accordance with the City Zoning Ordinance and may proceed as requested. This document when sign > the ry ne constitutes a temporary Certificate of Zoning corn lance d allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued. — /IA (e (Z— anm T - • • Dat Special Conditions, if any 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street Prior Lake, MN 55372 i f I I