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01 PRI0
ti CITY OF PRIOR LAKE BUILDING PERMIT, Date Ree'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
d/CIL'c,
r
kWES° ,
t:white Cit
. Pick City PERMIT NO. / a
3.Yellow Applicant i
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
li2q to With -car5c Pays► NW , Prior Lake a MU 5-5 -4-2-
LEGAL
52•LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) Girivi 11iVt1Vneir } einixet UL)Of Ste -eV (Phone) 1161 2i l 2220
(Address) MD W ilA 1, 9/X4S k)W► Prrtbr Lake, MO 5531 L
BUILDER
(Company Name) 4 Ute ?Dur 16 Cry (Phone) (..0*-1 LA
(Contact Name) 1 WW► ASChtI a-r (Phone) LD I 2.1.1% 2,51/
(Address) '1185 177e4er'AVe, hrw r blrnvc 1 iSats 1t-1 -1 55OiIo
TYPE OF WORK 0 New Construction 51Deck ['Porch ['Re-Roofing ['Re-Siding ❑Lower Level Finish 0 Fireplace
❑Addition ❑Alteration ['Utility Connection
CODE: C. DI.B.C. 0 Misc:
Type of onstruction: I II III IV V A B /�
Occupancy Group: A B E F H I M R SU PROJECT COST/VALUE $ 4.0 Y-..
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 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 gad VV1.I.11111444MC>(hog ext her) tbt,ts1 2 .10 V I to I tom
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ —( SAC # $
Plan Check Fee $ 8%6 ,/3 Water Meter Size 5/8";1"; $
State Surcharge $ J✓1.r1.> 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 $ Z 2- I - ('
This Al 4 B ..4 4 es Your Building Permit Wh 44 4 A 4,: .ved Paid Zi Zi (_(P S R ipt NO. it //
��iI � �� Date & r, ,t�
1:,.',►
Bin'."ng Official II to
This is to certifyli., th in the above•application and accompanying d.•, .is sin accordance with the City Zoning Ordinance and may proceed as requested. 7 his document
when signed byFee . . •..,notary C...�• of Zoning• ...'.,• and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued. �A .tr
i'
Pia a-F)ina-n.. ate Snerial('onrlitinnc if any ,
DEPART OF
PRIOR LAKE BUILDINGTMENAND INSPECTION
INSPECTION
RECORD
SITE ADDRESS 3 Zq(, Ji LL !46 6 p1'
TYPE OF WORK D _
USE OF BUILDING eer _
PERMIT NO. /4- . ¢9'O DATE ISSUED 6/ -/ 16-" _
BUILDER fl ft - W OU/See�7 PHONE # &V. Zi( 2-226,
NOTE: THIS IS NOT PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
IFOOTING /145`4_ic/4, f rrrz Mew?.r I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
14-14
I FINAL I %%i ' io )//
FOR ALL INSPECTIONS (952) 447-9850