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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
_, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" '
` ', ra AND UTILITY CONNECTION PERMIT 6-, 5 . /4—
�NE5d
l White File PERMIT NO. / 4��// 4
2 Ano City / (y �L' '
3 Yellow Applicant / ///
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
60 ' PX-t6 w .\A/.
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PE)
OWNER
(Name) . 0 el h &. .l (Phone) (I oZ" )£)CG " roC S,
(Address) ?-}-1 -)J) \fj C~.1 !
BUILDER (� n r
(Company Name) a16 � .- (Phone) -I be 'O9 q - (t),01
(Contact Name) �„�`'ST) r\0&64\(\ (Phone) I 50, - 9 a- (el 31
(Address) 1 7a'-) --3-0‘,,,,,,,--3-0‘,,,,,,, J 4P4Y\C (\X e----- f1ot., c l k, t_ ?•-'t 5563.71 p
TYPE OF WORK 0 New Construction Deck ['Porch ❑Re-Roofing ORe-Siding ['Lower Level Finish 0 Fireplace
['Addition ['Alteration ['Utility Connection
CODE: DI.R.C. DI.B.C. 0 Misc:
Type of Construction: I II III IV V A BC) �� 0O
Occupancy Group: A B E F II I M R S U PROJECT COST/VALUE $ •
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 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
o l• ..revo . •' for just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
v '61e ti57 )3% c11'lly
Signature Contractor's License No. Date
Permit Valuation 4 tV r — Park Support Fee # $
Permit Fee $ t U J (.)`, SAC # $
Plan Check Fee $ 6 (-1 5— Water Meter Size 5/8"; 1"; $
State Surcharge $ 2y/01) 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 `1 $ 17 i 1 S�
This Applicata eco Your Building Permit When A ro d Paid L 1 ( .7 S R apt No. 1 i 4-';"44
Date Ci c,l BY
Building O [tial D,e
This is to certify that , req 4: in the above application and accompanying.. m-...is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the ' ,7. constitutes a temporary Certificate of Zon".:corn....ce and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued. `-
mg - . Date Special Conditions,if any
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
DEPARTMENT
PRIOR LAKE BUILD NG A DOF
INSPECTION
INSPECTION
RECOR 'A
SITE ADDRESS .3. 3V�� O /266--)2 711/
TYPE OF WORK DE�K-
USE OF BUILDING �/�
PERMIT NO. /4 . SSI DATE ISSUED 6_ 5 - ��-
BUILDER XP/417 `/l/�j. PHONE N 95-2-, /07
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
1001W
I FINAL I qe2.z\ I y
FOR ALL INSPECTIONS (952) 447-9850