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C/
` PRj0 4 , CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
t - TEMPORARY CERTIFICATE OF ZONING COMPLIANCE /-5 /0
AND UTILITY CONNECTION PERMIT
dr .
4 ' NES O
1. White File PERMIT NO .
2. Pink City /O 50
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
5 7 Go Ck f / /1 R#, PRfo/U fl M<
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER pp "' a .,/t ° CIS (� ` 71I
(Name) /k� ✓o PR (Phone)
(Address) Y 7 !'. " (94,6:Ado ' / i 1 11/( /Zi( ✓ 3 2 ca
/
BUILDER
(Company Name) (Phone) 2
(Contact Name) (Phone)
(Address) v
TYPE OF WORK ❑ New Construction ['Deck ['Porch DRe-Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
DAddition ['Alteration ['Utility Connection p CODE: ❑I.R.C. ❑I.B.C. ❑Misc: G,.re.4TTAi. s
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 $
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
( 41 11 ■. - -_-_—'-/- . 74--. 60f 5 1 -1/i
ial can rev.ke this .ermit for just • use. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform neede inspections
igna re Contractor's License No. Date
Permit Valuation 5 v Park Support Fee # $
Permit Fee $ 25, SAC # $
Plan Check Fee $ l _°..c Water Meter Size 5/8 "; 1 "; $
State Surcharge $ . ; Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
P l umbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ 4 - ' is-
4 /( 7((m
This Ap l catio . B - h r ii e Your Building Permit ' en A proved � Paid � ..,5 Receipt No. LOS 70
A% IA lla
( Date 66 /15 /ld By t'
B:ilding0' = pat
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.
/canning Director Date Special Conditions, if any
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
RECOR
SITE ADDRESS E - ---4)
TYPE OF WORK USE OF BUILDING I / G. R2.
PERMIT NO. /0. 50/ DATE IS UED (j D
BUILDER r6"a4 e4 • # ?S' L-ZZ -C7 -
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
FOOTING 1 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
1 1
I FINAL 1 1
FOR ALL INSPECTIONS (952) 447 -9850