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;\ CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd •
TEMPORARYE(7.7 CERTIFICATE OF ZONING COMPLIANCE
ctrl '} 'r
AND UTILITY CONNECTION PERMIT
4W L,ga
I."tee File
PERMIT NO. (4 Z2.5
a. Pink City VV
(Please 3.Yellow Applicant
type or print and sign at bottom)
ADDRESS ZONING(dike toy)
C 1 n RRVI S( S IS()
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID L5. 140 . 0 0 1 . U
OWNER
(game) It 4-Q '"\,-e tFtr1 (Phone) ( I .:- 1('S'' 1LI11
(Address)
BUILDER c, f c�1 (t�
(CompanyName)Tly;tl C:hf,f 31�t)►,'1 14(i' QSf."6ry kk (Phone) 4"J I' )..S'.S N 1.N4
(Contact Name) U A i1 (Phone) GIL- 1 hs- t vi i? _
(Address) (4{011 krov.4-tC 04 Ct P...kA , (h N 'i ltf —
TYPE OF WORK 0 New Constntction ❑Deck ❑Porch ❑Re•Roofing 'We-Siding ❑Lower Level Finish 0 Fireplace
DAddition sigAlteration ❑Utility ConnectionGA``
S; 1,,.'.K 41+(' C11"-'"}'
CODE: .R.C. DLB.C. 1:1Misc:OVit 1```1 Jt)tc ()die.,:',y: CI(e.•1 S PN.Cri _
Type of C 'on: I II III IV V A 13
Occupancy Group: A B E F H I M It S U PROJECT COST/VALUE $ l l i k
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished infbanadon on this application which is to the best of my knowledge true and correct. I also certily that I am the owner or authorized agent for the
above-enc uioned property ty and that all construction will conform to ail existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
ollicial a revoke this permit fol4istfause. Furthermore,t hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X �l, s/ (1lk1Iii n ' _ I i I
Signature Contractor's License No. Date
—
Permit Valuation (0, 000 _ Park Support Fee # S
Permit Fee $ So SAC # $
Plan Check Fee $ /2-4
(.4"$ Water Meter Size 5/8";1"; $
State Surcharge $ Pressure Reducer $
Penalty $ S ' 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 Li jy_f . i $ 3 Z.O lc
This A „' ' Your Building Permit W Apr; ed Paid 3 20 .q Li R ipt No. 7r/,,j 7
Date 4- 11 :( By .
Buildi , _+ial Date
This is to miry that . quest in the above application and accompanying d rets in accordance with the City Zoning Ordinance and may proceed as requested.This document
when i geed r e C .ner constitu te:to temporary Certificate of Zoning pli, and allows constructio.to • ,, itegxe once a C to iccupanry must b.
4/S I¢ P:.- - if CO___
. Date Special Conditions.irony
__110. 24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
TMENT
F
PRIOR LAKE BUPLDRNG A DOINSPECTION
INSPECTION
RECORD
SITE ADDRESS (05-70 R-US11e' RA) ' —
TYPE OF WORK GFtteAqE Dam ALT'•
USE OF BUILDING ISS —
PERMIT NO. V4-. DATE ISSUED `F • Iia•
BUILDER "TWIAI CA1T Sl DltO PRUR$fIDAIEHONE # ,Si . 255• 2-04+
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
( FRAMING
( FINAL
G t.atiL
� IZI
FOR ALL INSPECTIONS (952) 447-9850