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o4 PRTo� CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �^_ ` '
......")
AND UTILITY CONNECTION PERMIT 7
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yr/'NESOP' I. White File
2. Pink City PERMIT NO. I A,. /`/) i
3 Yellow Applicant 1 I v
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER ) JIG dr,
C/� (Phone
(Address) /4:6v i' /,'"," di, e, a" 5F
BUILDER
., (Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction Deck ❑Porch ORe-Roofing ORe-Siding ❑Lower Level Finish 0 Fireplace
❑Addition DAlteration ❑Utility Connection
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CODE:Ai.R.C. I.B.C. 0 Misc.
Type o fir struction: I II III IV V A B
PROJECT COST/VALUE $
Occupancy Group: ABE F HI MR 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 for just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X
Signature Contractor's License No. Date
Permit Valuation V2_,c fj Park Support Fee # $
Permit Fee $ 4115- SAC # $
Plan Check Fee $ 3f ,04-,®4 Water Meter Size 5/8"; 1"; $
State Surcharge $ 1 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 1 $ TOTAL DUE $ tI s
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This A`l 'tio come j our Building Permit Wh Ap �ved Paid 1 9 eipt No. -<t 2
1 � gti_ �' Date e. 0 (4--
Building Official late
This is to certify hat th• equest in the above application and accompanying documents is in a• ord. ce with the City Zoning Ordinance and may proceed as requested. This document
when signed b j , C. 'lanner constitAis a temporary Certificate of Zoning compliance a .alto•s construction to commence. Before occupancy,a Certificate of Occupancy must be
issued. rr
r Pl. . Director Da e Special Conditions,if any
4 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372
LAKEDEPARTMENT OF
BUILDINGAND INSPECTION
INSPECTION
RECORD ) ,
SITE ADDRESSL' -
TYPE OF WORK
USE OF BUILDING cz r- -- _
PERMIT NO. (419 DATE ISS ED eg(Z-Z3'1-c (4k j
BUILDER V-te-• PHONE # _
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR a
FOOTING - );2-4 ' I ? l
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SI ED
#131150.-
IFINAL 'C.- b S \ILI
FOR ALL INSPECTIONS (952) 447-9850