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o� PRio* CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
Z3 �,
NNEso
AND UTILITY CONNECTION PERMIT `S 'C
44 4+' I.White Fite
City PERMIT NO. l*.
2. PinkPink4
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3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING 1'omce use)
t i-i m S, Je e(S ...ASS f('1 a' L1Ut 14114
I •
LEGAL DESCRIPTION(office use only) .
LOT BLOCK ADDITION PID
(Name)OWNE �'�6)• J ll i r (Phone) I 013 o r/ ( 3
(Address) I `T(15-5- jeapAr c p455 W '\ Pr i or I . . NI 0 55.3-)9- ,
BUILDER
(Company Name) (Phone)
— --
(Contact Name) (Phone)
(Address) .
TYPE OF WORK 0 New Construction (Deck ['Porch [Me-Roofing ORe-Siding DLower Level Finish 0 Fireplace
['Addition [(Alteration ['Utility Connection
CODE: .BC. ❑I.B.C. 0 Misc. .
Type of Construction: I II III IV V A B PROJECT COST/VALUE $
Occupancy Group: A BE F III MR SU
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 p•• ity 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
of 1 can revoke it for just cause. L s- 1 hereby agree that the city official ora designee may enter upon the property to perform needed -• ions.
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X 1' � b c' 0
Signature Contractor's License No. Ii ate
Permit Valuation -7.-6.) — Park Support Fee # $
Permit Fee - $ -I 3 ic- SAC # $
Plan Check Fee $ 47. 14 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 $ 122.(p A
This Appl do, :eco es Your Building Permit ti a App ved Paid ‘2-. 1.' - 6 Receipt No. '49 '
Date ) t4 By
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1 :;;fir I S 3 / 1
Bu 'ding. - Dat
This is to certify that the r-,uest in the above application and accompanying docume is in ac " •ante with the City Zoning Ordinance and may proceed as requested. This document
whienn signed by.1. ity A net I.nstitutes a temporary Certificate of Zoning co • rice a •allows construction to commence. Before occupancy,a Cert to of Occupancy must beiss
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S 3 1t l4t'Pa r) nil-F ldrale each Vim V
Planning Director - i , Special Conditi a,if an r4) 5.
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372
IC fog. 8 5
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PRIOR LAKEDEPARTMENT UILDING D�INSPECTIONI
INSPECTION
RE RapesSITE ADDRESS !�
TYPE OF WORK
USE OF BUILDING _ 4.011 �+
PERMIT NO. * t DATE ISSUED S . � _ �
BUILDER � � a� PHONE #(►IL. 23 _
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FOOTING All Ff7
PLACE1 eexi,-te
NO CONCRETE UNTIL
ABOVE HAS BEEN SIGNED
/N�
I FINAL ,O)A I t�o�,2,6
FOR ALL INSPECTIONS (952) 447-9850