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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
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i TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" "' AND UTILITY CONNECTION PERMIT
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1. White file /
2. Pink- City PERMIT NO. 1 3 -726 3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
1 5545 LO4 I+Ork zcx C,i SE, PMi LA.2 , N) SS? A
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER A ,
(Name) t� 'S \( 1�3�,C1, L) S` .o (Phone) SasO - S4 S— 4 L.
(Address) 5Sq 5 Le Si brill in C.;r SE, fir\ car Lai" ,MN Ss ),
BUILDER
(Company Name) (Phone)
(Contact Name) k..\-c (Phone) 3 C) "FRl -wa.Q L
(Address) 5545 l l-.S- lAbc11011 CA r SE ,Pc, of. Lo1ro. r f'-4N SS )d
TYPE OF WORK 0 New Construction Xbeck ['Porch ['Re- Roofing ['Re- Siding ['Lower Level Finish 0 Fireplace
['Addition ['Alteration ['Utility Connection
CODE: B.C. QLB.C. 0 Misc: Aa
Type of Occupancy A B E F H IV M c S U PROJECT COST /VALUE $ I boo
Division: 1 2 0 4 5 (excluding land)
I hereby certify that I have ftunished information on this application which is to the best of my kmwledge hue and correct I also certify that I am the owner or authorized agent for the
above-. • d propertty and t all •- . • ion will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the balding
official .. • this permit pat c�a Furthermore, . . Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed impectiois.
S' r• • • Contractor's License No. Date
Permit Valuation f - Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ r Water Meter Size 5/8"; 1"; $
State Surcharge $ , Pressure Reducer - $
• Penalty $ Sewer/Water Connection Fee # S
Plumbing Permit Fee $ Water Tower Fee # S
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ 64tes
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This r P ati , /',, _ v Paid (o 0, R No. 6 98/(Q
/ / / Date S. 2-?.(3 By .
Lam_ - (3
Building Official D
This is to certify ... .. request in the above application and ac • . any documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when s . b „, ty Planner constitutes a temporary Ce • . • :. of compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
A v.
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Planning Director Date Special Conditions. if any
24 hoar notic for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Mia.esota 55372
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DEPARTMENT OF
BUILDING AND INSPECTION
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InISrc‘o 11 0 N
R E 9 SITE ADDRESS
5` t -z.ar - C 9,,
TYPE OF WORK
USE OF BUILDING f3 A (/ / 7
PERMIT NO. (3 - rzio DATE ISSUED z.�. 1"3
BUILDER - - 1 , 0 5 & � , ¢ A X S s PHONE # 3 zo - . 83 -42 , ?G,
NOTE: THIS .IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
"s r/ & ic∎Por/ i. Pe, (1,13 f k$ 5 a.,.).„, INSPECTOR DATE
I FOOTING 1 r' I '3 .3 ° - ( 3
PLACE NO bONCRETE UNTIL ABOVE HAS BEEN SIGNED
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FINAL .#2111(i/
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FOR ALL INSPECTIONS (952) 447 -9850