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(3* PRt% CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
x AND UTILITY CONNECTION PERMIT
toi
'f'WNeso's`' I white File PERMIT NO.
2. Pink City ,A,_.2,00
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
i - ® ( F Tr21 I: L
LEGAL DESCRIPTION(office use only)
LOT, / BLOCK 1 ADDITION -I-Lc cane icy -+1,,,c,_, U 't 1_„--1 ` PID
OWNER )
(Name) r .N.)1.t c ,L 1 4 i
t (Phone) 9 5 LI - - ' -'3
(Address) I \ 1 v- 'lam Cc I I T -IL l'\ 1
I BUILDER
(Company Name) 1..U54 o 0 lie .5 ' C r\ I it c”- 'i t c (Phone) 9 5 -d- -4- t-s- _ Ii(.)
(Contact Name) t v c.-r..- 2 v ,p441^,..) (Phone) („_0 r - - 8 2- 7---6 C,
(Address) ) ( L C e cl. i P-: tU-$:I2 P)It/ii
T�OF WORK 0 New construction Deck ❑Porch ORe-Roofing ORe-Siding ,❑Lower Level Finish 0 Fireplace
i ❑Addis.n ❑Alteration ['Utility n t''�y
�,
COfl : Di.R.C. ❑I.B.C. 0 Mise. ((r 1)(4-""\10 I 'PLAC6 M ✓l
Type dit'Construction: I II III IV V A B
panty Group: A B E F H I M R S U PROJECT COST/VALUE $ , ODC)
(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 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
official can revoke this permit,for just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x - . .e- mss- c. co' r� -. t.3-1 t\ ` - 1({
Signature �� Contractor's License No, Date \
m; � ValuationPark Support Fee # $
Permit Fee $ Z.5 ,- r SAC # $
Plan Check Fee $ . .¢
Water Meter Size 5/8"; 1"; $
State Surcharge $ 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 $ 41 .7c"
This App:ration.:ecomes Your Building Permit en proved Paid 4 77-7- Receipt No. '
Date4-,r€a/ -` BY 0170 BY
ui dinitot inial = D e
is is to certify that the request in the above application and accompanyin:docume, s is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when sig ed b t e City Planner constitutes a temporary Certificate of Zo g corn.tante and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued.
t
-7'7---• ---',, ,,. 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 •
DEPARTMENT OF
PRIOR LAKE BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS t °-`M
TYPE OF WORK 194-
US
E OF BUILDING FE-5 Ajiz
PERMIT NO. r +. DATE ISSUED q-f v /-C
BUILDER roe"'N
6w +-rPHONE # G,f .- - 9261
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECT2R DATE
I
FOOTING (6:: I I K \
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
IFINAL I � l
FOR ALL INSPECTIONS (952) 447-9850