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O Plti CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
r AND UTILITY CONNECTION PERMIT
7.".> �i
koiNEs0tt. 1. White File
2 Pink City PERMIT NO. ( 10
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNE) �.
(Name) • "� Ike.: y ij (Phone) 3�
(Address) 1()& ¥ 31-ND 1-isg, � 1—
BUILDER yy ��� /�
E!
(Company Name) � k P (Phone) '172- 2- pia(` a r 1
(Contact Name) tri �� (Phone) 4 7 4 ;7— 'Z—Cf• 6 07
(Address)T.d.)x 0.0Y ST- �1R� � � i'90. S 5
TYPE OF WORK O New Construction ['Deck OPorch ORe- Roofing ORe- Siding ['Lower Level Finish 0 Fireplace
D Addition OAlteration DUtility C onnection ���r
CODE: I.R.C. ❑LB.C. $44isc. I isFc-P
Type of onstruction: I II III IV V A B PROJECT COST /VALUE $ ',Co. v
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
1 hereby certify that 1 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 -ment ed property and at 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 c. evoke this pw, Zit cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform need . mspe ions.
,I/ . g 8
IIIB gnature Contractor's License No. Date
Permit Valuation (01:0O r Park Support Fee # $
Permit Fee $
41 . rLj SAC # $
Plan Check Fee $ ZCo • 8 ( Water Meter Size 5/8 "; 1 "; $
State Surcharge $ e ciO 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 $ G 5Z,
This A icaty' Becomes Your Building Permit en A t .roved Paid a: -, Receipt No. OW
D Date 7 G By /A4
. iii dinsOft • a Date
This is to certi.,/ at • request in the above application and accompanying do tments i n accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed .i. e • t Plano r constltuts a temporary Certificate of Zonin. omplia e and allows construction to commence- Before occupancy, a Certificate of Occupancy must be
issued It
Plant : tor Date Special Conditions, if any
our notice for all inspections (952) 447 - 9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372
PRIOR LAKE DEPARTMENT
UILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS ` �
TYPE OF WORK ��P�9.. C�c)�
USE OF BUILDING 5 (Z
PERMIT NO. t3 DATE ISSUED 1/ ir3
�
BUILDER 5sr� � (Ek-t ef- .a+- osc�a+6. PHONE
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR J DATE
FOO PLACE NO CONCRETE NTR'ABOVE � BEEN C SIGNED
FINAL I /II, I / �/ /
FOR ALL INSPECTIONS (952) 447 -9850