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of / 041 . CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
( 4 —
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
/ AND UTILITY CONNECTION PERMIT / 0 //07
U i2
M,,'NESO „P I. White File
2. Pink City PERMIT NO.09 v 02 , 1 ,
3 Yellow Applicant
rint and sign at bottom)
ADDRES ZONING (office use)
/_S 6 7 /E'cI-. co; ,A- ec .s V p r), c LL,_
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
5 • ' 1/4,..... o ; c ,-,..., (Phone) qS2 y - /
(Address)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Constr c on Deck ❑Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B
Occupancy Group: A B E F H I M R. S U PROJECT COST /VALUE $
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have fttrnished 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 per- it f.rjust cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X /L
Contractor's License No. lit ate
Permit Valuation” (10 Park Support Fee # $
Permit Fee $ jr Z S- SAC # $
Plan Check Fee $ /(a Z 5 Water Meter Size 5/8 "; 1 "; $
State Surcharge $ ` SD Pressure Reducer $
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 \ $ 7�
This Application Becomes Your Building Permit When Approved ' Paid Y/, 7J Re pt No. , / 62,/
Date ld /L -c By
Building Official Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director 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
•
PR IOR LAKE BUILDING AND �INSPECTION
INSPECTION
RECORD
SITE ADDRESS �.55eP ifN /a3
TYPE OF WORK G77 U�J -
USE OF BUILDING e(2 /VA_
PERMIT NO. !/ 9. G 8Zio DATE ISSUED /G . /Z . G7
BUILDER J'rnU Nom✓ PHONE # 44-7 _X03 I
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
�( �
/1 I INSPECTOR DATE
1211/110A 1 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
l FRAMING
I FINAL 1 1 / 00/
FOR ALL INSPECTIONS (952) 447 -9850