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of PR_o�P CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
4r�4NES01r I wnne File
PERMIT NO. (3 /
Z Pink City
7 Yellow Applicant
--\ (Please type or print and sign at bottom)
r ADDRESS
ao 1-� 0 ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID) qb3-- N Q-0
),.._ OWNER Inn
(Name) ►t' `T---re R con P(— ' (Phone)
(Address) 3-3 .0 Toon cIz fJ
BUILDER 1
(Company Name)C�OLI'� J tR l..-C I C' )C? (Phone) CO / 1 a,a I LI S- S5
t.
(Contact Name) La IC JLTA (Phone) ( 1) E5 3$4.Ss
(Address) Ol l�‘..{ SGJc1 tow -01I ion :,:11-1,642.,04. NIA) S933q
TYPE OF WORK 0 New Construction ❑Deck ❑Porch ORe-Roofing ORe-Siding ❑Lower Level Finish 0 Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE ]I.R.C. DI.B.C. 0 Misc
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 hereby certify that I have tarnished information on this application which is to the best of my knowledge true and coned I also certify that I am the owner or authorized agent for theabove-men ned property and that all consnuction will conform to all existing state and local laws and will proceed to accordance with submitted plans I am aware that the building
( official c. r yoke tats permit f ust cause Furthermore,I hereby agree that'the city official or a designee may enter upon the property to perform needed inspections
x AIL. CGS (03 i a...a-- id/wi r)
Signature Contractor's License No, bate
Permit Valuation t 0°O ^ Park Support Fee # $
Permit Fee $ 40,-7 SAC # $
Plan Check Fee $ -Z i) c Water Meter Size 5/8"; 1"; $
State Surcharge $ `�v 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 $ Gi Sk)
This Appl' ti BecomessYour Building Permit Whe Ap ved 'Paid (O .J e, Receipt No �l7O1
Date 117742,7i..517742,7i..564 By
t7 (
Building t3filci, - Date
This is to cern that the .equest in the above application and accompanying docu nts is accoidance with the City Zoning Ordinance and may pioceed as requested This document
when signed b i the Cir} 'tanner constitutes a temporary Certificate of Zoning co .bane'and allows construction to commence Before occupancy,a Ceititicate of Occupancy must be
issued •
(Z (,
Planni : : • D.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
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS 3 (9
TYPE OF WORK t)(
USE OF BUILDING �-- �--
PERMIT NO. /3 ; /34 DATE ISSUED t 2-/co (�
BUILDER 6,9(-4 , PHONE # ( z - .308 -. 7g
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
f INSPECTOR DATE
*MING1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
itWNW (4-� $1,,--7L" Ca �i�r acs
L FINAL ) ] " 7
FOR ALL INSPECTIONS (952) 447-9850