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MY OF PRIOR LAKE BUILDING PE IT, Date Rec'd
ALI TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
*v E S
I. white File PERMIT NO. /3 '7Z tl
2. Pink City
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
■ 00 ,2. Ci (7 1 )111 CT tJ l J ' '5D
LEGAL DESCRIPTION (office use only) ,
LOT/5 BLOCK / ADDITION /3/u %?"5 d r f V(.)r Ih`✓C I) PID
OWNER `/ /1 ,^ -7/ 3 7�
(Name) ) y t e '7/y Mif' r i4i')*t i - !°C (Phone) ! l7 7 " ?CO ?C _ 77�
(Address) S o L=
BUILDER / pct . / .. q
(Company Name) ids /-40-ti" / S . (Phone) 952 - 6 /6i- g
(Contact Name) % f/1-sJ W 0 l Q (Phone) 6 1 Z - Z - b 79J67
(Address)
TYPE OF WORK ❑ New Construction ❑Deck orch DRe-Roofmg DRe-Siding ['Lower Level Finish ❑ Fireplace
DAddition ❑Alteration ❑Utffityt crnnection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc:
Type of Construction: I II III IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COST /VALUE $ 75
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished ' ation on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized a for the
above - mentioned property an a onstruction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am a e building
official can revoke this it for c . Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed ins ons.
X i r. ,--2,-9„, Az Signature L Contractors License No. Date
Permit Valuation R 1 0 d Q Park Support Fee # $
Permit Fee $ rL $e) • SAC # $
Plan Check Fee $ l g . Water Meter Size 5/8 "; 1 "; $
State Surcharge $ $r 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 $ q•l 0.. -
This A .1ic . n Be Your Building Permit . en pproved Paid & . di Recei et t O i er E . VA �
1 Date IL. By C-1
I �
I �. ■ - t( f
:iii . ing Official Dat
This is to cert hat the request in the above application and accompanying docum is is i accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed . e 1 Planner consettutes a temporary Certificate of Zoning com iance d allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
'4 �-� n f3
r Plan . g Director Date Special Conditions, if any
• our notice for all inspections (952) 447 -9850, fax (952) 447 -4245
46 Dakota Street S.E., Prior Lake, Minnesota 55372
CITY OF PRIOR LAKE
Impervious Surface Calculations
(To be Submitted with Building Permit Application)
For All Properties Located in the Shoreland District (SD).
The Maximum Impervious Surface Coverage Permitted in 30 Percent.
Property Address / ( z 9 7 hen ka.
3 9,3
Lot Area 8 3 30 Sq. Feet x /o = 3 2 7 V
LENGTH WIDTH SQ. FEET
HOUSE x =
x =
ATTACHED GARAGE x -
TOTAL PRINCIPLE STRUCTURE / 3 i 3
DETACHED BLDGS x
(Garage /Shed) x
TOTAL DETACHED BUILDINGS
DRIVEWAY/PAVED AREAS x =
(Driveway -paved or not) x =
(Sidewalk/Parking Areas) x =
TOTAL PAVED AREAS 7 / $
PATIOS/PORCHES/DECKS x = 1 ( 6 poa` 7-/
-J (Open Decks 1/4" min. opening between x =
boards, with a pervious surface below,
are not considered to be impervious)
/✓,
TOTAL DECKS
OTHER x =
x =
TOTAL OTHER
TOTAL IMPERVIOUS SURFACE —a-6-9-3- 224 (
tom•
' + OVER /ol3 "
Prepared By K%4,--,.'s 44t Date 9- 3 -/e)
12-61A7-i Ave Pte/'.
Company A4,, Qe' /-Uc. Phone # 9s0- 4/3z- 347610
(.
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS tU/ ( CT'
TYPE OF WORK
USE OF BUILDING
A- /F---
PERMIT NO. DAT ISSUED '7 tI ( 3
BUILDER Ft > � n 1`-) dk PHONE # (Z z4 °i c(
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE NSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUM ENT
INSPECTOR DATE
IFOOTING C 1 , ?/3 / / /t
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
FRAMING "kir Frw.r. Pe- g C I 0) I ieejc7
817
FINAL 1 ? I
FOR ALL INSPECTIONS (952) 447 -9850