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(ebo+r, CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd TEMPORARY CERTIFICATE OF ZONING COMPLIANCE (0 Z. / 3
AND UTILITY CONNECTION PERMIT
t=7 Nesp11' I. white City PERMIT NO . / / /
2 Pink city / t �
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER � F I _ �,
(Name) W� A S 1ty Bir-y e-i ( (Phone) '?S ) _ `' — COS 1
(Address) t. t. 14'; ia. ..e. ,
BUIL ) ` Tic (Phone) c fS 3 ' — 4 57 (3
Com an Name) �'�
(Contact Name) � r te.. - (.-c..s„ iw, (Phone) GO- _ `No _ 7/Q
(Address) 3.06-74 C./..,2, C 44U Tr( L
TYPE OF WORK ❑ New Construction eck ❑Porch ❑Re- Roofing 0Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteratt n ❑Utility Connection
CODE: DI.R.C. DI.B.C. ❑ Misc.
Type of Construction: I II HI IV V AB 5 .�� � —
Occupancy Group: A B E F H I M R S U PROJECT COST /VALUE $ J �`�
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
offiici 1 can vo • this pe - mit for c Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X Bic LraS-I co -ai- /3
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ � �� • �, 117.75 SAC # $
Plan Check Fee $ 7 to . 61 Water Meter Size 5/8 "; I"; $
State Surcharge $ Z 5-0 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 I $ TOTAL DUE C ilaeou 6,,, z. ,r $ /9 7t7
This • . , lic 'o : ecome our Building Permit When Approved Paid /9 6 ' (c £ Pt No. (e y y/ -
// _A ,Z Date 7-8.1/
� Buil m ticial Late
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 -4245
4646 Dakota Street Prior Lake, MN 55372
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS I5 I / 14' I la„.,€ /4tte
TYPE OF WORK (2) b.ack S
USE OF BUILDING 2 F b
PERMIT NO. DATE ISSUED 6/211/(3
BUILDER 0.4SavtnVc OcAL5V, PHONE #
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FOOTING 1 c A
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I FRAMING 1
I FINAL 1
FOR ALL INSPECTIONS (952) 447 - 9850