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�F PR IO R CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
,, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
U it
y'N I White File
Pink City PERMIT NO. ( 3 , ( Of
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
3 5 1<e �is,ti e in q ve A 16 1 lc
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER ,( J
(Name) / ( / 4,1 t'1 i /'T • (Phone)
(Address) 3? -3 ke45/A:11 41 etue Pr /;, / [/
i BUILDER �� �,// /� Ole tt j
�• (Company Name) / 4 i-i r''7 Cr s f iUc 71 /ey G� G (Phone) C' /2 / G� �/ D
g'
/ \ (Contact Name) /l4( tl "� - .0.h (Phone)
I (Address) ?(7 ; 14 %o m et /I/ /'t/ 4/4/(4( .11S /JV
TYPE OF WORK ❑ New Construction eck ❑Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish C1 Fireplace
❑Addition EAltera on ['Utility Connection
CODE: Ii /LR.C. ❑LB.C. ❑ Misc. v k P'S
Type of t on ction: I II III IV V A B
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $
Division: I 2 3 4 5 (excluding land)
1 hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct, 1 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 revoke this permit for put cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspectit ns-
X �jL g6, 3 7 <5 5? l /�/3
Stg rn8 a Contractor's License No. . Date
Permit Valuation ^�.'? Park Support Fee # $
Permit Fee $ I -; --/- S0 SAC # $
Plan Check Fee $ b(4).(7) 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 $ TOTAL DUE $ Z' (,(
This • p' • ti , Becomes Your Building Permit Wh Appro d Paid "Z ..r Receipt No. 7W
ifi gt�� �� Date 7 l0 „ By Pr
13 ilding ti Date
This is to certify at th - - ucst in the above�a icanon and accompanying documen is in acco ante with the City Zoning Ordinance and may proceed as requested. This document
when signed /Pe Cit nner constitutes a temporary Certificate of Zoning compl nce and a tws construction to commence. Before occupancy, a Certificate of Occupancy must be
issued
y/ (3
la
n • 'rector / Date Special Conditions, if any
24 ho r notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS AE-N.67*/v6),A) /C
TYPE OF WORK C
USE OF BUILDING /
PERMIT NO. (3 - /d // DATE ISSUED .' (lo (3
BUILDER di - T - 6, Yom HONE # ,, '� - ,Z
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
IN CTOR TE
FOOTING �:
PLACE NO CONCRETE UNTI ; = OVE HAS BEEN'SIG ED
I FRAMING 1 1
I FINAL 1 a 1 10 !9` l3
FOR ALL INSPECTIONS (952) 447 -9850
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