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3j CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
i ' TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
U I L \ \ z
AND UTILITY CONNECTION PERMIT
5 0
1. White File NO. 2. Pink City PERMIT NO 13 q
1
3. Yellow Applicant ` 1
(Please type or print and sign at bottom)
ADDRES S ZONING (office use)
/
i I /C0 Coni o y •S+ 4E V_-I S p
LEGAL DESCRIPTION (office use only) , I /�
LOT BLOCK ADDITION PID " (1 `4 - D ( v
OWNER / j� �J o�— Jt7(p�� /�
(Name) J a, O/i �/ e n n i al K (Phone)
(Address) M' 0 CO i r ay Sr, /V E
BUILDER
(Company Name) IVt / . ` �6�� /�� y�
ay n um 6 on 51 rgd�i'on Conron �/ (Phone)
(Contact Name) X y'I e S �!' e9 e- / (Phone) (d) 'P8 * W'6
(Address) / 7'(0 .3 Qf / 5r. Et 1-44ev; Ile MA/ ,SSoN 4
TYPE OF WORK ❑ New Construction ErDeck ❑Porch ❑Re- Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration DUtility Connection
CODE: 0 I.R.C. DLB.C. ❑ Misc:
Type of • a. • , coon: I II III IV V A B
Occupancy Group: A B E F H I M 1 S U PROJECT COST/VALUE $ 3;30
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and e.arr.... 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 't for just cause. Furthermore, l hereby agree that the city official or a designee may eater upon the property to perform needed inspections.
X / ? 1775 10 ` /?` /i
" t= e' Contractor's License No. Date
Permit Valuation CY,e Park Support Fee # $
Permit Fee $ 13-15" SAC # $
Plan Check Fee $ 41 • 1_41C Water Meter Size 5/8' ; 1"; $ /
State Surcharge $ ! ` _ Pressure Reducer I i
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 $ l 22 ( q
// I
This Applies . ■ ∎ Becomes Your Building Permit ' . , A , , , , Paid 1 22 - 6 q Receipt No. I O 'cps
Date !o // o f /3 BY 05/ J
. / 11) (�
B d un , 2 Date
This is to ccrti at the re. , in the above application and accompanying .. • . - is in . ••• . • with the City Zoning Ordinance and may proceed as re. :< d. This document
when signed • +. P . I.: c. . • ∎ ' a temporary Certificate of Zoning •,., . . • . t . allows construction to commence. Before occupancy, a Certificate • Occupancy must be
issued. • � � t0 f ( 1. i� S• .! ,a i . ... d- / A ) I►C._, -'' i AO
Special Conditions, an
'Ian ng ." .. ,, r � SPce s, Y
24 hour notice for all inspections (952) 4479850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
PRIOR LAKE s DEPARTMENT U
BUILDING AND �NSPECTION
INSPECTION
RECORD
SITE ADDRESS 6,4"--0 Cofv' -.-�s-
TYPE OF WORK � ��
USE OF BUILDING '�5 A- (z
PERMIT NO. f Af '3 � - h' �` ' 4,� DATE IS ED jO a (�
BUILDER 1V�A�•'M L '+4«warzd -i PHONE # /tz •Si8 - Z'tR(o
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT DATE
IFOOTI L NO CONCRETE UNTIL AB
INSPECTOR �H'AS�EEN SIGNED
*NNW
I FINAL 1 /4 /// 7 1
FOR ALL INSPECTIONS (952) 447 - 9850