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04 PR I04,
47/Nc.;; CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
`ill AND UTILITY CONNECTION PERMIT
N -
N E S °
" .c.
I. City PERMIT NO. / 3 / 5 ... 4. Vr
(Please type or print and sign at bottom) 3. Yellow Applicant
ADDRESS ZONING (office use)
Z&&3 C3u142 7 . SF
LEGAL DESCRIPTION (office use only)
LOT / BLOCK / ADDITION / fU 5 PID
OWNER .�
(Name) `,,,.... J' /4' (Phone) e / Z '1I - 1— (a S'7`f
(Address) l g3 ea 1 r,(,►t 7,�it,,'6 /1.1, Ai ,
BUILDER
(Company Name) /VA (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck DPorch ['Re-Roofing ❑Re- Siding l9.ov8er Level Finish ❑ Fireplace
DAddition DAlteration ['Utility Connection / `
CODE: DI.R.C. DI.B.C.
❑ Misc:
Type of Construction: I II III IV V A B ' Ob
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $ N ,.�j UDC, --
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
official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
7 j 4+ - `. -' . . `le' Contractor's License No. Date
—
Permit Valuation i Park Support Fee # $ ___----------
000 yr9G•
Permit Fee $ 3.41 • - SAC # $
Plan Check Fee $ `( Water Meter Size 5/8 "; 1 "; $
State Surcharge $ • 5-0 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 $
3S, 2.5— i n Beco' es ... Building Permit When Approved Paid Rec 1 t No. (8 1(
„ .....7) .
Date 2/25/, By -
0/26
13u i 1 - Official D
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 S.E., Prior Lake, Minnesota 55372
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS o g 5 �du --
TYPE OF WORK L. L , l,`. Roo,
USE OF BUILDING
PERMIT NO 1 DATE ISSUED '725
BUILDER .)a, 5 7 r94 PHONE # 6i2 (1V-( 77/
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I I l I
PLACE NO CONCRETE UNTIL AB�VE HA BEEN SIGNED
I FRAMING f Z 1 h 1
I FINAL 1 6 I r(?6 .) 1
FOR ALL INSPECTIONS (952) 447 - 9850