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O Pkt CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE q /3
.. AND UTILITY CONNECTION PERMIT
U
tv 4'NNESO*°. l White File PERMIT NO . /_
2. Pink City /3, 6; Z7
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS _ (office use)
3 x 5 LA Y1 fc C.-t- 5 G'
y
LEGAL DESCRIPTION (office use only) Q (�
LOT-6 BLOCK �y� ADDITION 1 ' `ci elC. G 1 e v ? RD , PID ' 4-15 • U °4- -
OWNER l�O w`� � � 1 % L 2 5 0 4'I 2 S
(Name) Rovuttc\ lt� (Phone)
(Address) DS 5 u h ,re C'r' S i-✓
BUILDER
(Company Name) 0.--d A (✓ (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction (Deck ❑Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition DAlteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V AB PROJECT COST /VALUE $ S S 0 0:7
Occupancy Group: A B E F HI MR S U (excluding land)
Division: I 2 3 4 5 t
1 hereby certify that I have furnished inform•tion on this pplication 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 -menu• • d prope Ty a•d that all , ons' uction will inform tall existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official c )kc t is erm for) st • use Thermo w hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
5 / r61 f21.)t3
Signature Contractor's License No. Date
Permit Valuation
zi
Park Support Fee # $
I (70D•OC
Permit Fee $ ( • p6 SAC # $
Plan Check Fee $ U‘ . t5 Water Meter Size 5/8 "; 1 "; $
State Surcharge $ 2. CU 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 $ 1
OE FI ��' `' JII4f•
T • ppl• , ion Be mes Your Building Permit r ,..„...„,.,,
When Approved • *said Recei. t No. c��' ii• 6 ev date (_ ,' B
Builil pie Official Date
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 BUILDING AND AND�INSPECTION
INSPECTION
RECORD ^C
SITE ADDRESS vV savmy erJm/
TYPE OF WORK
USE OF BUILDING
PERMIT NO. 13 • 6Z1 DATE ISSUED G.
BUILDER iE:O4KOWSr.." PHONE # Z$O, 4FT+3
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
IFOOnNG
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
1 1
FINAL 1 2 .1./ 1
FOR ALL INSPECTIONS (952) 447 -9850