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(.4---PRI O+P CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
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TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 4- I b
.. AND UTILITY CONNECTION PERMIT ' ��
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41Hne0'0' L_ j i Pink FileCitI PERMIT NO. Z
/ 3 Yellow Applicant � t ��
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
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LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID Z ike. odZ' 6
OWNER , 0 -2,--
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(Name) ',i!' 5� '' 1't‘ r' Y + CIV� LL (Phone) . — _it ' 7 ) ., ,)
(Address) ?- } f:l"-i l' V. '..!4' �'tar� ` �,/(/V S S 7
BER
(Comp nyy Name) �i `w { ' , ' �� � Cr - ((Phone) (s �-220 2,(0(C1
(Contact Name) -**-e// /filer (Phone)
// /!/4/ (Phone) til-21U--"z 79
(Address) 12.Q " -- 1 �, ` Ci N9— -- rpt)„`t.. /4A.I cG'6 -1
TYPE OF WORK 0 New Construction speck ❑Porch ORe-Roofing ❑Re-Siding ❑Lower Level Finish 0 Fireplace
❑Addition ❑Alteration 0 Utility Connection
CODE: DI.R.C. DI.B.C. 0 Misc
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ /'O/‹.
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and con ect I also certify that I am the owner or authorized agent for the
above-mentioned property and that all contraction 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 peimit for Just cause Furthermore,I hereb a! ee that the city official or a designee may enter upon the property to perform needed i pectin s
X /4 --(ii33-305--- i C 2�.9 i
Signa • • Contractor's License No. Date
Permit Valuation •j/ c o (J Park Support Fee # $
Permit Fee $ 13 75 SAC # $
Plan Check Fee $ 47 94- Water Meter Size 5/8"; I", $
State Surcharge $ / 0 0 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 DUE 2 1--,
16 /IV'''. $ %ZZ ��
This Ap, .••ti,' Becorktes Your Building Permit ' en A' ' oved Paid /L.�f- Re ipt No. 7(17/
Date 2 j,/- B
►4' 1'1
—.ur nim:"•'I Date
This is to cell' tha tl e request in the above application and accompanying documents in accoi.knee with the City Zoning Ordinance and may pieced as iequested This document
when sign i th' y Plannei constitutes a temporary Certificate of Zoning complia ce and all s construction to commence Before occupancy,a Cciti icate of Occupancy must be
issued
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/ Plannt ; I - • Da e Special Conditions,if any
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372
DEPA
TMENT
F
PRIOR LAKE BUILDRNG A DONSPECTION
INSPECTION
RECORD
SITE ADDRESS 37-17 --fmt•sEg" Dom''
TYPE OF WORK DFiGe-
USE OF BUILDING IZEs
PERMIT NO. t 4-- . 22_2- DATE ISSUED ±- - L 5 • I4--
BUILDER Df'U.I-M60b 13ULL.DEPS PHONE # (nIZ• Z?A • LGG7
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FOOTING I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
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( FlNAL � 1C)4--‹ - � I ) `f \ I�
FOR ALL INSPECTIONS (952) 447-9850