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o � PRi CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
- AND UTILITY CONNECTION PERMIT -“, r
FILE `Y(91
4„ I I. White File PERMIT NO.
Pink Aity
3 IC - 00 Si 4-
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID 1 - A 14_602.-c.
OWNER r—
(Name) (Phone)
(Address)
BUILDER
(Company Name) _ .'' C:1\..) A 1 NI T E x4,61∎1 Cam. (Phone) 7 &S _ Sc _ -2-5-41C—
(Contact Name) - T - e - V 1 -C – I G6 K (Phone) • ' 9 - _ 0
l (Address) 100 1 0.,,L5 '1 4 E. D [ /•44e N 6-340
TYPE OF WORK ❑ New Construction ['Deck ['Porch ❑Re- Rctofjjrg ❑Re- Siding ['Lower Level Finish ❑ Fireplace
['Addition ['Alteration ['Utility Connection
CODE: ❑I.R.C. I t B.C. ?Misc. c I C N
Type of Construction: I II HI IV IC' A 4f2 PROJECT COST /VALUE $
Occupancy Group: A B' E F H I ? R S U (excluding land)
Division: 1 2 3 4 5 1
I hereby certify that I have furnished 1. ormation 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 pro. rty and that onstruction 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 r- .. a this permit for . use. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
inspections.
X • i _ 1.......__ (9-' -r I0
_• •gna ■ - Contractor's License No. Date
Permit Valuation 5 0 p Park Support Fee # $
Permit Fee $ 2 5 SAC # $
Plan Check Fee $ i Z� Water Meter Size 5/8 "; 1 "; $
State Surcharge $ - Sr) 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 $ Lk lc
This A /1' at' Becomes Your Building Permit en pproved Paid 4'i ,/ ipt N�JJy 3‘
Date 2-. CO B
Building Official ate
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
/ -
, 0-/-/
. nning 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
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PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS CO low c2 61.1 Sr N • E.
TYPE OF WORK
USE OF BUILDING I G rJ tw
PERMIT NO. DATE ISSUED z (L 1 I o
BUILDER S • 11 . L.. ELc nt c.AL PHONE # 7G.?, _s5°■ • 382z
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
FRAMING 1 1 1
FINAL 1 1
FOR ALL INSPECTIONS (952) 447 -9850
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