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OF PRJ CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
U x AND UTILITY CONNECTION PERMIT
4 "/NNESOl t ' I. white File / 3 ✓ c ,
2. Pink City PERMIT NO . Q
3 Yellow Applicant G�J'�"/
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
k44St k' 01---
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER -
(Name) _J r 0/-k f aTh (4a, G vel in G (Phone)
(Address)
BUILDER M 1A C l/1" `/'' ( ( - SO7 S�i S7
(Company Name) C.�- (Phone)
(Contact Name) l 0 v t''I of y (Phone) 6 (2 FSS61 -9 2 -, 7
(Address) / 0 5 / (6,5eV el VC I / e I
' ) ('D ) c. (714 c-\ S f - I 5 �
TYPE OF WORK ❑ New Construcpon ❑Deck ❑Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition PO Alteration ❑Utility Connection �/
CODE: DI.R.C. I.B.C. ❑ Uv Misc. ie pa �'r �a ' d �' -
Type of Construction: I II III IV V A B
PROJECT COST /VALUE $ S 0 0°
Occupancy Group: A B E F H I M R S U (excluding land)
Division: I 2 3 4 5
I hereby certify that I have fu • ished information on thi. 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 propel , nd that all const icon w I 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 .ermit for Just cause. Fu • e ore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X 1 L ` ` `e---- 6C 063 2a.5 7 2-71 73
Signature Contractor's License No. Date
Permit Valuation ,7.--C2j Park Support Fee # $
Permit Fee $ 1 3. ? �, SAC # $
Plan Check Fee $ + ?._ q i' Water Meter Size 5/8 "; 1 "; $
State Surcharge $ t — 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 I $ TOTAL DUE $ t 22. 69
This App1i L • i n : comes Your Building Permit ' en Appro ed Paid rZ4 • `,Mil Reeei . t o - , #7NAINII
Date _ B in
Buil Int; . Date
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
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 - 4245
4646 Dakota Street Prior Lake, MN 55372
C
PRIOR AKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS 144 DE)V.
TYPE OF WORK g eick( — /q6r ` -
USE OF BUILDING
PERMIT NO. ( 3-8c77-- DATE ISSUED 74er
BUILDER l &t) PHONE #
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I FRAMING / 1 1PP 1
t ANAL g 'G\711
FOR ALL INSPECTIONS (952) 447 -9850