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,� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
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AND UTILITY CONNECTION PERMIT
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I. White File PERMIT NO.
_. Pink City / 7 ^)
3. 'fallow Applicant
7 �
(Please type or print and sign at bottom)
ADDRESS l� (� l L ZONING (office use)
1 "(�/ V I ` ) ( lA t �. w C' e (i r t E V(t'A, ke ihl N 55 3 7: t ' L i`7
LEGAL DESCRIPTION (office use only) (�
LOT 4 BLOCK 1 ADDITION S & c 6 -' O �r <�. ? f' PID
OWNER ;-� /
(Name) V) (5V t� l c.,S , 6t ' bV q (Phone) [ 5 - y / 2 - 2 6 g
(Address) 10'15 CAndlet.>oce Cif NC, ?rivr I-4 tee .✓1ai 5537
BUILDER l
(Company Name) � U S M' 1-(1C- (Phone) (i52-6q1
(Contact Name) - 3 - 0 , -)i C�ckU t:'t ice t nd (Phone) - q7 g v
(Address)
TYPE OF WORK L/ New Construction ❑Deck [Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
DAddition ❑Alteration ❑Utility Connection
/ i
CODE: DI.B.C. ❑ Misc: (')/ irc 57
Type of f struction: I II III IV V A B
Occupancy Group: A B E F II I M R S U PROJECT COST /VALUE S 1 1
f 0 00 1 00
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 knowkdgc 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. 1 am aware that the building
officia revoke this • - mil /•r'ust cause. Furthermore, I hereby agree that the cit y may enter official or a designee ma ee upon the property to perform needed inslteaions.
X , 41.16 .41 . !�
.�l tr.55 413 (0/11//)3
Signature Contractor's License No. Date
Permit Valuation 3e2 . - Park Support Fee # $
Permit Fee $ '30- - SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1 "; $
State Surcharge S r J Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee S Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ ( 4 7, i (
This A / ` leati • ay s Your Permit n Ap ved • M lu Q� R • • i • t No. i ' &'�'IMI
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..a4. 41 -izi ' /8 / to 2 � i 3 B S A.-
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This is to •- ; that t e • uest' • the above application and accompanying • • • ■ments in accordance with the City Zoning Ordinance and may proceed as requested. This document
when s' ,' • the C , • • constitutes a temporary Certificate of Zoning • • ' ce and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued. /
I
Date Special Conditions, if any
24 hour notice for all htspectioa• (952) 447 -9550, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS 4 ) ' Ci (2_
TYPE OF WORK x f Ste' i
USE OF BUILDING ° -� (P-
PERMIT NO. /3 -4 Z3 DATE ISSUED 6-, (g (3
BUILDER Do(a.:..�5 t ( i�--t .TS � 1 PHONE # ' 2 -'1-(Z z6 Z67
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
FOOTING j I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
411510MW 1 1
I FINAL 1 /0 /-
Dr() iG, vk. Does rnoi` hkP.�
beck ; S P�e�- P o� �--�.
FOR ALL INSPECTIONS (952) 447 -9850