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O FPRI0 •P
CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
t`, / TEMPORARY CERTIFICATE OF ZONING COMPLIANCE , ! -
` AND UTILITY CONNECTION PERMIT
�r F So .�
wh "` '°t`
PIA Car PERMIT NO.
App ?Off
3 s'.n�,,. Applicant
/3 •
(Please type or print and sign at bottom)
ADDRESS ZONING (once use)
3U 0 A r: ,,, (1. i tA/
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER {{��
(Name) is rrc. to mc4 1 $$ l (Phone) 6.42_7_,160 -3_6 � �S
(Address) 3 6 6 , ,,,. C _ ,c t-r--
BUILDER
(Company Name) r) / I _ t �' r . (Phone) 76, 3-.26, --. ? /
(Contact Name) OGt ✓, vt r , c.p.,,c1_er-- -- (Phone) 6/.— ,Fee m°
(Address) L Y 15 2 j ` S7' A} t1/ �r,A Sao »2 1 t/
TYPE OF WORK ❑ New Construction Deck ❑Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
['Addition ❑Alterat on ❑ Utility Connection
CODE: DLR.C. IILB.C. ❑ Misc:
Type of Construction: I II III IV V A 13
Occupancy Group: A 13 E F III M R S U PROJECT COST /VALUE $ V700
Division: 1 2 3 4 5 (excluding land)
I hereby certify that 1 have furnisl d inf rmation on this application which is to the test of my knowledge true and etrrrttY. t also certify that I am the owner or authorized agent for the
above-mentioned property and t at all . instruction will conform to all existing state and heal laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke this pc . fit just c. se. Furthermotc, I hereby agree that the city official or a dcsignce may enter upon the property to perform needed inspections. ( I VY
X IMO g Signature Contractor's License No. Date
Permit Valuation 3, 000. 0 0 Park Support Fee # S
Permit Fee $ S 0 . 1 SAC ## $
Plan Check Fee $ 57. 3 G Water Meter Size 5/8 "; 1"; $
State Surcharge $ / 50 Pressure Reducer S
Penalty S Sewer /Water Connection Fee # S
Plumbing Permit Fee S Water Tower Fee # S
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE d � A , -y Gt � ( Cj a ' $ /4-7. ` r
This Applica . n / comes Your Building Permit Whe A
p Paid / Receipt No. /:
b . Date . 6-.2, > / / yj / % J 4-
/ If By
"!cot'r,- Official 1 c
This is to certify that the re ucst 1 the above application and accompanying do cunients is in a 'ord ce with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City er j L st i tutes,p temporary Certificate of Zoning compliance an allow construction to commrnce. U occupancy, a Certificate of Occupancy must be
issued. \ /
Dirc 41111
Date Special Conditions Walt'
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.F.., Prior Lake, \linnesata 55372
•
PRIOR LAKE
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS 3 27 O B`LlEN �
TYPE OF WORK DEW.
USE OF BUILDING ik H
PERMIT NO. I3 . 905 DATE ISSUED e . (•
BUILDER ONE - J / () p �Lfa''�, /��. PHONE# 263, 263. 3s7r
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSP O� � DA
FOOTING PLACE NO CONCRETE UNTIL-A': • E HAS BEEN IGN D
1 1
FINAL I % — -� I 7/0 j
FOR ALL INSPECTIONS (952) 447 -9850