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CI
Ot4 f P Rio CITY OF PRIOR LAKE BUILDING PERMIT,
Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE q,361 t /3
x
x AND UTILITY CONNECTION PERMIT
U
,y, NEso ��, 1. white File
2 Pink City I PERMIT NO. /3 , /CO 0
H
3 Yellow Applicant
(Please type or print and sign at bottom)
ZONING (office use)
ADDRESS �..
► 5b5i -- x, 00 i ' -
�f'
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID 45, oi4. 0
OWNER t,,Y 4'V 1 (Phone) &12 7 --530
(Name) ' Al.,' t� ,
(Address) 11 11
BUILDER �L1. ? /i - 73 213- 3 1 3
(Company Name) � (Phone)
(Contact Name) ; - (Phone)
(Address) 1746 I A& N v∎1 Coevl �v1415 1" I N 5.91
TYPE OF WORK ❑ New Construction ykeck ❑Porch URe- Roofing ❑Re- Siding DLower Level Finish ❑ Fireplace
❑Addition ['Alteration ❑Utility Connection
❑ Misc.
CODE: .R.C. DI.B.C.
Type of C s truction: I II III IV V AB PROJECT COST /VALUE $ I ) O
Occupancy ' roup: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
1 hereby certify that I ave furnished information on this application which is to the best of my knowledge true and correct- I also certify that 1 am the owner or authorized agent for the
above- mentione• .r. , t an tat 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 r ) fs r ,. r just cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections -
/� 2wa2> 't? eve /t
X f • • Signature Contractor's License No. Date
Permit Valuation 4 Park Support Fee # $
Permit Fee $ /03_60 SAC # $
Plan Check Fee $ 6 t4 7 95 Water Meter Size 5/8 "; I "; $
Pressure Reducer $
State Surcharge $ 0. , Q c)
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 1 $ TOTAL DUE e 4h3 $ /7 95
This App tion B •' Your s Yr Building Permit Whe , proved Pai / 7/ 9 Receipt o 7 / Z4
I Date /012-1 By ( L
lbd .. a.4121•. to h
Building Ofhcia - state
This is to certify at t c re tic in the abov • ..plicatite and accompanying do i nts is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed , 1 e • n r i ' taut : porary Certificate of Zonal. • 0 • .Hance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued
e ' ���_ b 1 r 3
1.M/ .. •ia � �� Planning Director ■Ill■ 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
PRIOR LAKE BU AND INSPECTION
INSPECTION 1
RECORD �
�
SITE ADDRESS / 0 ' 'ALP&
TYPE OF WORK •
USE OF BUILDI G :_ a S L
PERMIT NO. Ph; � S ATE ISSUED PHO E�' .E 5131 ✓ . t -
NOTE: THE PERMIT IS BY SEPARATE DOCUMENT
NSPECTIONS BELOW
INSPECTOR DATE
FOOTING ;ila to Y 0
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN E SIGNED I
FINAL _� WAI � ���
FOR ALL INSPECTIONS (952) 447 - 9850