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4��, 4 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
mil` / TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
c.' \c / I AND UTILITY CONNECTION PERMIT l'. 2-3.12_
' AW E S
I. White Fite
2 Pink City PERMIT NO. /2 3 ost
.
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
g ..... /
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) Yl - + cs 4 '0_t v (Phone) 9 SZ - Z & - `i Fs 0
(Address) 34.8 1 Ss k'�— T- Gi v- . '
( C o
BUILDER �� E . c �
(Company Name) (Phone) "i Z - Z z `i ' 7 ZZS y
(Contact Name) VI (—V- -( T- v v (Phone) 152 -z1 - 7 ' Z U 0 Z T
(Address) e3Co 931 6. ,.i Li ! 31 V'2- H'...3 `x'3'7 8
TYPE OF WORK ❑ New Construction ❑Deck ['Porch ['Re-Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
['Addition ['Alteration ['Utility Connection
'
CODE: [�I.R.C. ❑I.B.C. ❑ Misc: �- 2 ),
f ' '
`
Type of Construction: I 11 III IV V A B
Occupancy Group: A B E F III MR S U PROJECT COST /VALUE $ 4 f)M.) .
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 permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X 06.< -f 7e- p.-c-e-,z----- 13 c. - S '7 Cv 3E3 4/ z /ZO 1 z
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ 103. — SAC # $
Plan Check Fee $ CIpCv .aS Water Meter Size 5/8 "; 1 "; $
State Surcharge $ t. 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 $
rt. t .q S
This ' . plicati • 1 r co p , Your Building Permit Whe Appro ed Paid t 1.95 Receipt it in d
i ,
//,' Date 24 B
I • -- - --- Date /
This is to c. ' -, that the re • est in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when sign y the Cityj n onstitu,tes a temporary Certificate of Zoning co . fiance . d allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued. L
1 ' r 4 ' 24- rZ to stl c
Manna . t ate p ecial Conditions, if any Deco_
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS C I .
TYPE OF WORK lC stt6j
USE OF BUILDING 1z &• (z-
PERMIT NO. k DATE ISSUED 1- - /z BUILDER -- 1 1 -->F - e-(-6s,0 PHONE # asz• zz.4. 7z ar
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FOOTING 1 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
imMIONEW
I FINAL 1 '%
FOR ALL INSPECTIONS (952) 447 - 9850