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of PRlpR CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 6 q.
..U x AND UTILITY CONNECTION PERMIT
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•IN____-- I. white File
2. Pink City /*PERMIT NO. S.----t.)a
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3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER ],
(Name) �CYC iANN K c1,( (Phone) (452— � l'1 -
(Address)
BUILDER
n a (Phone)
• (Contact Name) (Phone)
(Address) •
TYPE OF WORK ❑New ConstructionDeck ❑Porch DRe-Roofing ['Re-Siding ❑Lower Level Finish ❑Fireplace
['Addition ❑Alter o ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑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 forlust cause Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X ..--7,,,,.2,. .----7----,...._._.____ 6,- 9-ze y
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Signature Contractor's License No. Date
Permit Valuation L--/ 000,c) 0 Park Support Fee # $
Permit Fee $ /u 3.0 0 SAC # $
Plan Check Fee $ 6 6 /.r`A Water Meter Size 5/8"; 1"; $
State Surcharge $ z r 0 0 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 $ /7 (_ 1 j
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This Ay.:cal on Becomes Your Building Permit n ' ,proved Paid /(;� / /.S Re t No. 7/5()/57/5()/I - Date c !� B
•
ii I r it
.•tai i •tal Dat.
This is to certify Ali the e'nest in the above application and accompanying documents in ac.•rdance with the City Zoning Ordinance and may proceed as requested. This document
when signed b �{ ity 'nner constitute temporary Certificate of Zoning complia e and allows construction to commence. Before occupancy,a Certificate of Occupancy must be •
issued. / /r. /
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����rt t . or aag Special Conditions,if any
4 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372
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PRIOR LAKE DUPE
DING DOINSPECTION
INSPECTION
RECORD&307 �,
SITE ADDRESS �D7 _
TYPE OF WORK
USE OF BUILDIN ��,It -
PERMIT NO. / 't" 504 DATE ISSUED G. 9. dm-
BUILDER RIDe/'f �.Al�.Ey PHONE # 9S2_20/. �
NOTE: THIS IS NOT A PERMIT FO�i ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FOOTING I ��-. 161 IC (Ei �
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ONO* 1
FOR ALL INSPECTIONS (952) 447-9850