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of PRi CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE /..5: /3
z7) x
ri, AND UTILITY CONNECTION PERMIT
4 tNNE SOl P I. White File PERMIT NO . /3 z i 4 _
3 Ye City L
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
0,3 04e 'a -eI A J W
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER G f, /� { i C
(Name) ti f fL e// %'t e 14, 1 (Phone)
(Address)
! BUILDER f
(Company Name) 074' i / r / / S/4 /.0.2--e552-
S /PIC/ (Phone) (� 7
(Contact Name) 3 Off, n i l' a 1. / SP AI (Phone)
(Address) 13.E �
?4,k bil eie 4,/, ylkl � N (fit
TYPE OF WORK 0 New Construction Deck ❑Porch ORe- Roofing
0Re-Siding ❑Lower Level Finish 0 Fireplace
❑Addition OAlte tion ['Utility Connection
CODE: I.R.C. ❑I.B.C. 0 Misc. __
Type of Co struction: I II III IV V AB PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
1 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 1 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 revo - • this permit for just ause • rthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
1 X / a 6 73 2 ) /3
Signature Contractor's License No. Date
Permit Valuation b Park Support Fee # $
Permit Fee $ 1 L 9 SAC # $
•
Plan Check Fee $ R - f 3 Water Meter Size 5/8 "; I "; $
State Surcharge $ �? 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 1 $ TOTAL DUE m 3 ,'$ y3 $ yZ I .6 3
This Ap cati . n : , ./ our Building Permit Ap , oved ZTr „ � Recei . t No — , - ..
•••••..... �9 Date B 4111/A
Building Official Date
This is to certify at t re./ .t in the above application and accompanying docum is is in ccordance with the City Zoning Ordinance and may proceed as requested. This document
when signed . the C ' er onstitutes a temporary Certificate of Zoning com lance d allows construction to commence. Before occupancy, a Certificate of Occupancy must be
iued / ���
'4 Ire` cg c
Plan's �— D to Special Conditions, if any
24 hour notice for all inspec tons (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372
PRIOR LAKE DEPARTMENT
A DO
INSPECTION
RECORD ,
SITE ADDRESS 2023 EDC�EIKdoD D�. NN
TYPE OF WORK DETK
USE OF BUILDING garVL
PERMIT NO. 13. 24- DATE ISSUED 3, IS. I.3
BUILDER EJ[TF„IC/O/L 50/16S.S/OAI.'f /NG PHONE N (Ft 959. 7(56
THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
FOOTING (-! s.ar- f3 3 -ao —)
PLACE NO CONCRETE UNTIL ABO E HAS BEEN SIGNED
loarom* r(-0A,,, LUC.— I 1 07 I
I FINAL 1)terite— 1 1 `if lG�J3
FOR ALL INSPECTIONS (952) 447 -9850