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of PRJ(lP CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE g 21,, 14
ft e7. AND UTILITY CONNECTION PERMIT
Q tri
4/NNE50lt' z. nk City PERMIT NO. I _
3 Yellow Applicant i /.r(- '
(Please type or print and sign at bottom) {
ADDRESSZONING(c[free use)
3S?07 gi eitz le-4/ 6//-2.
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address) l/l i2
( o BUILDER 1/2 ! l�J T 7 q5)_- 1/0-la i /
(Company Name) v�CY`�Q� ie �f rrJ>: J � (Phone) ,
(Contact Name) A _= h(e , (Phone)
(Address) /6?>a W Z„,()L' Ave
LT TYPE OF WORK ❑New Construction Deck ❑Porch ORe-Roofing ❑Re-Siding ['Lower Level Finish ❑Fireplace
9
['Addition ❑Alter ion ['Utility Connection
CO Ilie
CODE: r 1 .R.C. ❑I.B.C. ❑Misc.
Type of o • ction: 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 1
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 thi permit or just ca se Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform necde•Q1nsp �/
1 x , , Signature Contractor's License No. Date
Permit Valuation iOO 6 Ob Park Support Fee ## $
t
Permit Fee $ 103. 00t
03• 0 O SAC
Plan Check Fee $ f_4 Pic Water Meter Size 5/8"; 1"; $
ZState Surcharge $ , 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 $ 1
Gas Fireplace Permit Fee $ TOTAL DUE $ `,1 1 1 All
This Appiati to Be o ej , r :' ilding Permit When Ap v oved Paid n‘- `, ReCel NO.
Date ,til• (`l By
D.
A .,
Building Official i, e
This is to cerci - at the en nest in the above application and accompanying docu nts is in ace dance with the City Zoning Ordinance and may proceed as requested. This document
when signed , he City ';
n r constitutes a temporary Certificate of Zoning co pliance and lows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued
,��� ` •
& te7 I 4--
Planning Direc• D Special Conditions,if any
24 hour notice fo all inspec ons(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372
DPRIOR EPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS 3547 Ilie OXY _
TYPE OF WORK a eX _
USE OF BUILDING x _
PERMIT NO. / i •v DATE ISSUED . 2* 1
BUILDER it PHONE # . / .�
. NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FOOTING � ---- 11'
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SI NED
IOW �
I FINAL I I
FOR ALL INSPECTIONS (952) 447-9850