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PR/04CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCEAND UTILITY CONNECTION PERMIT J' 3ES°�
1.White File I //'
2. PPERMIT NO. A ,
Pink City
3.Yellow Applicant "�/��
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
5-LID D Ar.15-0 wood p-R iv C
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) Th c%/4-4 CO13c b c► - (Phone) 6 6 - a3.7- 39 61
(Address)
BUILDER
(Company Name) p,,-//e��L4 S IM .. re.f;atr (Phone) to I a - S1 7 - 0 S 0 4.
/�
(Contact Name) es.wi y ✓h.o (Phone)
(Address) 690 ar o4 ST- C Co Ko-c rn.A1 s v 3 a-1
TYPE OF WORK ❑New Construction )eck ['Porch ORe-Roofing ORe-Siding ['Lower Level Finish 0 Fireplace
['Addition ❑Alteratio ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. 0 Misc:
Type of Construction: I II 1111V V AB
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ /y e to d
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
official can r thist just ca . Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X ` r Bc. fnc 7 /S s s —x&— >y
Signature Contractor's License No. Date
Permit Valuation 5.7) 0, 0 0 Park Support Fee # $
Permit Fee $ -S– ® Cs SAC # $
Plan Check Fee $ / G, 2S— 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 $ 41:7 7 3
This Application Becomes Your Building Permit When Approved Paid 1. /(....... ' Recei o. '7t y
Date/ 3o ( By .
Building Official Date
(
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner 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 S.E.,Prior Lake,Minnesota 55372
DEPA
TMENT
F
PRIOR LAKE BUILDRNG A D�INSPECTION
INSPECTION
UCORD
SITE ADDRESS rn'sJWdôo 01...
TYPE OF WORK Qarri�i imam* 1 snithes•
USE OF BUILDINGLNitPERMIT NO. I T• DATE ISSUED Sl. Oillim•
BUILDER arc= wJ/J/reo PHONE # &/Z,. am 40t
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
10101110
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
MVPS
I FINAL � nti `Z L i $ IAF
FOR ALL INSPECTIONS (952) 447-9850