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' 04 1t I , 4' CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec' d
\ 7 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
rri AND UTILITY CONNECTION PERMIT 7 3 (- 13
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(Please pe or print and sign at bottom)
ADDRESS ZONING (office use)
r _______q
7G0 Pc -I i- e P uss
f i-i c�i- L ke, NIN 55:3
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) .' US cc. h C c C i c 1-, (Phone) 0, 1 Z — 80 1 9 94 G,
3 70 0 Po ■- Pa ss
(Address) r k c Lc, k e 1 iv) kl .S"5' 3 7 2
BUILDER
(Company Name) Q LA W lr y fri n wine n w n , e i- (Phone) !o / 2 — 80 1 9 4 4
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction ®Deck ['Porch ORe- Roofing ORe-Siding OLower Level Finish ❑ Fireplace
['Addition ['Alteration ['Utility Connection
A . CODE: Z[.R.C. DLB.C. ❑ Nine:
Type of Construction: I II HI IV V A B
Occupancy Group: A B E F A I M R S U PROJECT COST/VALUE $ 200o, 0 0
Division: 1 2 3 4 5 (excluding land)
I hereby =Iffy that I 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 - 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 just cause. Furthermore. I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X . �_ C c ` . '':�17 31 l 2013
— Signature Contractor's License No. Date
Permit Valuation _ 2. G 0 0 0 0 Park Support Fee # $
Permit Fee $ 73 , 15 SAC # $
Plan Check Fee $ 4 ( / 6 . Water Meter Size 5/8"; 1"; $
State Surcharge $ / 0 0 Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechar; ical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOT . ' D ```` $ / a Z _ 6 •
This A Becomes Your Building Permit Approved Paid F df�_ Re. • • t N! . i , �1�
/ ( C `a Date g ft/ /_I By f/' . i ,
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This is to certify that t h e r e q u e s t in t h e a b o v e a p p l i c a t i o n and accompanying .. •• .. ts : in accordance with the City Zoning Ordinance and may proceed as requested. This document
when sign - • e Zoning ..... • . , • and allows construction to commence. Before occupancy, vpancy, a Certificate of Occupancy must be
issued. , ��l Planner constitutes a temporary Certificate of Zo
f'
"..d ilk - Date Special conditions if any
ra"-s, 11,
1.-7.44.; .
PRIOR LAKE DEPARTMENT
DR G AND �INSPECTION
INSPECTION
RECORD
SITE ADDRESS 3 PoiVTE PI�JSS
TYPE OF WORK D CIC
USE OF BUILDING 4E n//C
PERMIT NO. 13 , (43 DATE ISSUED 7.3/. 13 BUILDER cAnciew PHONE # G/L, 84I. 4 /946
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE I FOOTING 1 ,I5 A: 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
WNW" 1 1
FINAL
FOR ALL INSPECTIONS (952) 447 - 9850