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CITY OF PRIOR LAKE BUILDING PERMIT, Date i.Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I.White
z. Pink CityPERMIT NO. /5. a X14.
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(oefice use)
LEGAL DESCRIPTION(office use only)
LOT 4 BLOCK j ADDITION /4612-7-4-WOo iiird1100 PID
OWNER
(Name) I (Phone) C`-02, o7/ J. 6 3
(Address) 2J& -- ) '"i4ou-I241)6,-i be-, ,)'2 (oyZ LMB
BUILDER
(Company Name) (GC3r36T CT/'f (Phone) _
(Contact Name) oo✓t5 M E (Phone) 9 S-01-• 9
(Address) (-7-9 5 C ,DRC •4 S /fi t[., ISN
TYPE OF WORK 0 New Construction eck ['Porch DRe-Roo
fang ORe-Siding OLower Level Finish ❑Fireplace
['Addition ❑Alteration DUtility Connection
i6• LZ
CODE: R.C. DLB.C. 0 Misc:
Type of onshuction: I U III IV V A B / odo
Occupancy Group: A B E F H I M R SU PROJECT COST/VALUE $ / O-e, _
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have ed' . don 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
..ve-mentioned property,..d that all•• .'on 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 • ....' for just cause. .' , ermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
/ lac 6 c( e//5
y ignature Contractor's License No. Dat
Permit Valuation 4- 000_ j U Park Support Fee # $
Permit Fee $ /03_ 0 D SAC # $
Plan Check Fee $ GC qS Water Meter Size 5/8";I"; $
State Surcharge $ Z Q 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(- g jr'
T7tis A:', ,, Becomes arour Building Permit A. ved Paid /I/ /%r Rece No. 92��'
�� P it (� Date l B
BuilDat
This is to certify t the , in the above application and accompanying ents' in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed. n'ty' er constitutes a temporary Certificate of Zoning co pilo re and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued.
talk
/'PI Director Date Special Conditions,if any
hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS a5 IC/AJ eL"' - <v Uic-_
TYPE OF WORK
USE OF BUILDING i'3' /9//z---
PERMIT
9/ --PERMIT NO. /C. z-7¢- DATE ISSUED 4-- 1-
BUILDER
BUILDER / iS0,/ PHONE # 917.9f1-• 44377
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FOOTING �33
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I FINAL �� 40‘,/.6-
FOR
0LFOR ALL INSPECTIONS (952) 447-9850