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I CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT /,
en ~lNNEseiP 1. White File
2 Pint: City PERMIT NO./3 / Z Zq
3 Yellow Applicant /
(Please type or print and sign at bottom)
ADDRESS / ZONING (office use)
l , ‘7 /'9 i T ?G 5 - V-3
LEGAL DESCRIPTION (office use only) ,,��,,� Z Jl
LOTS BLOCK 1 ADDITION B' -�- 2r � fJ PID�5 -- (IC
OWNER .\ �
/� (4.3/2 G
(Name) 1V 1.C) / ► t LA (Phone) S -/ (166.3
(Address) / 61 6/0 fral.t/ kL J ) 74(--. eicilteX., 95 Z33 , f 3 L.G;
BUILDER
(Company Name) S'a41/.. 4 is p illy (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction [Deck ❑Porch ❑Re- Roofing DRe-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: 6.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V AB �^�,
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $ 2av )
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 correct_ I also certify that 1 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 revo -t is permi r st c use. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
I X 1/1264
Si a re Contractor's License No. Date
Permit Valuation j SO o _ o0 Park Support Fee # $
Permit Fee $ 57 5D SAC # $
Plan Check Fee $ 3 - 3 0 Water Meter Size 5/8 "; I "; $
State Surcharge $ ► 75" 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 I $ TOTAL DUEL M. /• /I $ 95:63
This Ap.licatio : • coin • s Your Building Permit Wh- ..roved Paid ?_5, 6,3 Re 'pt No. 7C �t�
{) L l j 0 Date /I. /- /..Z By _
Buil ing Ott "nil Date
This is to cent t, that t • quest in the above application and accompanying doe me is is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when sign• S the CI �, ` an .- constitutes a temporary Certificate of Zoning c mp ance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued. , ' "'
11 r ( 3
s 1 ' - etor 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
•
•
PRIOR LAKE BUILDING AND �IN SPECTION
INSPECTION
RECORD ,,t
SITE ADDRESS /G�j �/ F�IVj
�•
TYPE OF WORK
USE OF BUILDING jag I¢pR.•
PERMIT NO. IS. /Z21 DATE ISSUED O. 1/3
BUILDER 4A241/ PHONE # 6tL. 597 4443
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FOOTING AX: I '6 )l�c,� <,
PLACE NO CONCRETE UNTIL ABOVE HA B EN SIGNED
- FINAL
FOR ALL INSPECTIONS (952) 447 -9850