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PRICITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ` (Z tAND UTILITY CONNECTION PERMIT
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NNNteso'tt. White Fite /4...
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2. Pink city PERMIT NO. Lf i
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS Syq az-Trak I kJLCt4• Lam(f?Vl Of(.a1(L4, ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
(Naame) + G IR" b&u,ioitaS (Phone) asts 5ezi.2
(Address)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New ConstructionDeck ❑Porch ❑Re Siding ❑Lower Level Finish 0 Fireplace
DAddition ❑Alteration ❑Utility Connectio
CODE: 4I.R.C. DI.B.C. 0 Misc.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $
Occupancy Group: A B E F H I M R 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 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.
5li a1V
SPr Signature Contractor's License No. ate
Permit Valuation 3, o 00. 0 V- Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ c-7. 3G, Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
Penalty $
1 .-Cr) 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 dim,&-0 ,S' l4 $ /4-7,
This Aiiic,tion is ‘o i, s Your Building Permit Whe Appr i ed Paid /47.I f Re ipt No. 7 il.74(--
l //i . r, Date S. /6, /4 ,
Building Of ficialBig
This is to cert that he request in the above application and accompan 'ng do ments is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when sign'. iy thir ity Planner constitutes a temporary Certificate of onus ompliance and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
i.issued. ,
Tann 6' cto 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
EATMENT
F
PRIOR LAKE BUILDRNG A DOINSPECTION
INSPECTION
RECORD /�(�
SITE ADDRESS S70,1a0/4/6019 ^ _ •
TYPE OF WORK Dag-
USE
OF BUILDING PERMIT NO. J4T3 /IJ DATE ISSUED . a..A/T
BUILDER et)W#914625- PHONE N 952. 245% 52,1
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
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I FOOTING I "��- -- I 31 (�
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
141110*/
IFINAL I`ra"`t- I Z(z� I ��
FOR ALL INSPECTIONS (952) 447-9850