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of PRI0� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
0,� TE i ' I ' ! CERTIFICATE OF ZONING COMPLIANCE
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AND UTILIT ' - 11 • h. CTION PERMIT
4fA'NBSolt' ,�` ' �
4 . I lute File
Fl
�,t,1 t Pink Cay PERMIT NO. (y 13
t Yellow Applicant -/ i
(Please type or print and sign a ... orif
ADDRESS ZONING(office use)
��OO- - 0642 /;tet ac
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER ..--7, .i
i/707 3/ ', —6-3a –2—
-75
(Name) /err il l fi5t(,( e ,_Jodi � SCV1 (Phone) , if
�.(Address) �j ( � � .
&i - �.R/ �, - 1
v
BUILDER ,,A A ,a /
(Company Name) /�� " l 4'1/ /✓l e (Phone) /A ' (.2k.,2-`3-- S'--7
(Contact Name) //Pat''t ye'5 (Phone) ,
(Address) /0 5 /OS(' ,i'li=r 7' �i/�-4' t_ zh5 /4 d�-ti
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TYPE OF WORK 0 New Construction tirDeck ❑Porch ORe-Roofing ORe-Siding ❑Lower Level Finish 0 Fireplace
❑Addition ❑Alteration 0 Utility Connection ,,� /�
CODE: ❑I.R.C. ❑I.B.C. a-Misc --c�(f:, hS' C C 5/c.,(. 5
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ /'>
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5
I hcieby certify that I have rnsheC d irmation on tins .plication which is to the best of my knowledge true and correct I also cetufy that I am the owner of authorized agent for the
above-mentioned property and t. all cons .' w 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. rm of Just cause Furt• ore,I hereby agree that the city official or a designee may enter upon the piopeny to pei form needed inspections
Signature Contractor's License No Date
Permit Valuation y�'!J v ,Q) Park Support Fee # $
Permit Fee $ 7i5.--- C573, SAC # $
Plan Check Fee $ /6 .LS— Water Meter Size 5/8"; I", $
State Surcharge $ ` S-® 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 ei -0 61/4/1/¢ $ 44 t-75—
This Application Bec' es Your Building Permit When Appr ved Paid g!,7{ ReceiptN 712-4/u
1 Date h7,✓31/X• By ,/s.}-'..,
Buildm,s Total Date J
This is to certify that the rquest in the above application and accompanying documents is in accoidance with the City Zoning Ordinance and may pioceed as iequested This document
when signed by the City Plannei 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
• rt
DEPARTMENT OF
PRIOR LAKE BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS 002- WEST d fr/C PO ( T t1�
TYPE OF WORK �� - S71
USE OF BUILDING gel gfit--
PERMIT NO. / . 3 (3 DATE ISSUED -` • l' -14
BUILDER /1 11 W M PHONE # 6(z- • S/61. ?`Z81
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I 4120MINr
I FINAL
FOR ALL INSPECTIONS (952) 447-9850