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of mood CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 2., . S, /3
.. AND UTILITY CONNECTION PERMIT
44fpEso't" I. white Fite PERMIT NO.
3 Fell Applicant /� /O
3 Yellow Applicam
(Please type or print and sign at bottom)
ADDRESS/6 411,1' 7 11/:-t a %,, Z ING(office use)
Ali
JrLL1 .4.t-44-f, At ,V 5377c)-
LEGALDESCRIPTION(office use only)
LOT BLOCK ADDITION PID
C6/Z_ GGD. 7J34
OWNER / A`/ �` 6—R-- p
(Name) C.-oofM � S. l (Phone) 4p/d —G.CX-d— G .igo
(Address) 7' ,5701 7 ' r /),C- 4r11......' 5-s-7-7
BUILDER •
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Constrpdtion ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish 0 Fireplace
❑Additionplteration ❑Utility Connection
CODE: DLR.C. DI.B.C. 0 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-mentio/ d 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 oke this,t for Just cause- Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
,..\....
X / . II Ar 2i51 l2,
Signature Contractor's License No. Date
Permit Valuation SGS r- Park Support Fee # $
Permit Fee $ 7_s SAC # $
Plan Check Fee $ I C .lc Water Meter Size 5/8"; 1"; $
State Surcharge $ j Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ 541, 50 Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ Or /9 5
This Applica i Seco e. Y r Builditlg Permit When •p i ved Paid /, 2� ec pt No. �p�f– I
/!'f/� to /.3 Date 2, G-!�
Building Official - _---- D to
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions,if any
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS 164024 NQ R.D.
TYPE OF WORK //.1ThP40jL dz7a41; 6/�/ MAI)
USE OF BUILDING f
PERMIT NO. DATE ISSUED 2. 5. 13-
BUILDER s/J/7 PHONE # 6/2. Cr °p.
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FOOTING I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
FRAMING P LU{'"t f3 l N '__ I (r ' We `" '
11n5cJ( L uG r3�6 A/tc. /e A 'ly
i FINAL I ei / /(/ /‘--
3Cz
FOR ALL INSPECTIONS (952) 447-9850