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PRio CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,,, . TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT 5 / & - 43
K ..._ T NNESo I. White File NO. 2 Pink City PERMIT NO / 42�
3 Yellow Applicant ! i .....i1
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/ p�
! (9 .3 IA) t ide of eS Tr. - E. 4 IS()
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID ZS- 310. O2.
OWN �R !l Ct i ' 1 i q 4' f k 4 vT LS (Phone) .w /1 y/O 1 7 ?D
(Address) ) 76 c)3 � ) t i t i o 19 CS5 / C a 5. 6: / r:jor ).g ee, .S27?-.
BUILDER
(Company Name) _TO h 'fO Cd CO 1I (Phone) 3&Q' 33-97 p
(Contact Name) To h ii -Ft) i4 (Phone) 6 s 1 3 D 3S 7,F
(Address) c9 0 ,/ VS (' ( r" / sk 6 fair")) ;4/ fo `I Al d a /
TYPE OF WORK ❑ New Construction Deck ❑Porch ❑Re- Roofing DRe-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc. y�
Type of Construction: I II III IV V AB PROJECT COST /VALUE $ V v�
Occupancy Group: A B E F HI MR S U t
Division: 1 2 3 4 5 (excluding land)
1
1 hereby certify that 1 have punished information on this application which is to the best of my knowledge true and correct. 1 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 re oke this per orlt t cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X t a 437.3 Y2
Signature Contractor's License No. Date
Permit Valuation 3 ` O o o.. 0 o Park Support Fee # $
Permit Fee $ 0 g 2 ,5 SAC # $
Plan Check Fee $ 57 3 to Water Meter Size 5/8 "; 1 "; $
State Surcharge $ / _ rT Pressure Reducer $
Penalty $ V 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
p CpuEn s' ilo.i3 $ `4 I / %/
This Ap ' do : 'comes Your Building Permit Wh Appr ed �� �, Receipt No. /Wit , i Date By
11111. ■ 1� /� % s- , 0 13
Bui 7 Date -
This is to certify that the re. 'S in the above application and accompanying documents ' in accor.. ce with the City Zoning Ordinance and may proceed as requested. This document
when signed by ( P n ( constitutes a temporary Certificate of Zoning complia e and a .ws construction to commence. Before occupancy, a Certificate of Occupancy must be
issued
Planning . Da: 9 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
A D�NSPECTION
INSPECTION
�
RECORD
SITE ADDRESS /7023 WI406/e4/55S , T
TYPE OF WORK Da/C.
USE OF BUILDING /PES11A.-
PERMIT NO. I 3.435 DATE ISSUED 3. 17, /3
BUILDER TOffiV FOKQ ejA/SjX.,, PHONE # &3/, $08.35'
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
(FOOnNC 1 � ^I1 - �
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
FINAL 1 el.Lp,.r I /0/74//3
FOR ALL INSPECTIONS (952) 447 -9850