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U? a o a ❑ ❑ ❑❑ v ° °`i
of P>Eti� CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
F ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Z !�' /2... .
AND UTILITY CONNECTION PERMIT /
�
4j, qP I. white File pERMIT NO
A'IVESO 2. Pink City /- - Z / 7
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/l/Y ' Ta471/ c or iti L,,___}
LEGAL DESCRIPTION (office use only)
LOT, BLOCK ADDITION � jllr i 5 & / / % be/ Cl. S PID
OWNER 1 i /��
(Name) fl Ga It L c Kl n 4th,it s, (Phone) e — 2-3 6 32 /
(Address) /i 7Zhtall /17(.4_)' I
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ADeck ❑Porch ['Re-Roofing ['Re-Siding ['Lower Level Finish ❑ Fireplace
❑Addition ['Alteration ❑Utility Connection
CODE: c R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B PROJECT COST /VALUE $ _
Occupancy Group: A B E F HI M R S U (excluding land) G ed
Division: 1 2 3 4 5 0 6'
I hereby certify that 1 have punished 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 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 permit for Just cause, Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X2 ,/6 A 312172-
Signature Contractor's License No. Date
Permit Valuation — Park Support Fee # $
Permit Fee $ be . 2-5 SAC # $
Plan Check Fee $ .2,47 Water Meter Size 5/8 "; 1 "; $
State Surcharge $ i .50 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 $ 147, r
This • lie io comes Your Building Permit ;App ved Paid / 7 / / Re t No. (��
J Date %, / L B
.uildine • Icia Date
This is to r ify /at ti a equ • t in the above application and accompanying d cument s in accordance with the City Zoning Ordinance and may proceed as requested. This document
when s i by i e / '1 •n et constitutes ademporary Certificate of Zonin compli ce and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued / /1
3ar 17 .--
clot 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 /62 3 / WV -0A./ c
TYPE OF WORK
USE OF BUILDING y 1//fz- -
PERMIT NO. C 2- . / DATE ISSUED - z ' (`a-
BUILDER i( /%- / &- PHONE # Zd % • Z.3G -5741
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FOOTING 1 ( j 1//s
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
1 1
I FINAL 1 1
FOR ALL INSPECTIONS (952) 447 - 9850