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o� PRIp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
U �j
44,NEse' 1. White File
2. Pink city PERMIT NO. j3 ,(06(
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3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING loffrce use)
11( '%9 Anrrq Trl,
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNERA A ` J, '
(Name) I I'S • SDI ccs e.(1 (Phone) t_N1 — as462.
(Address) Sci r►1 C
BUILDER _
(Company Name) r( \�fkr`--c.�1 i c(`/\ k C ' . (Phone) a-LICA/`3.'33
(Contact Name)rrZr( A (Phone) sct c
(Address) 1 k0`-1 SO k4.9 e i5 Sr- CT
TYPE OF WORK 0 New Construction DDeck ❑Porch ORe-Roofing ORe-Siding ❑Lower Level Finish 0 Fireplace
DAddition ❑Alteration 0Utility Connection
CODE: .R.C. ❑I.B.C. 0 Misc.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $
Occupancy Group: ABE F HI 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 a,;ent 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 t ' permit f lu cause Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X aliado qy 1 ?>
Signature Contractor's License No. Date
Permit Valuation '7-7=" r Park Support Fee # $
Permit Fee $ 7 3,1 SAC # $
Plan Check Fee $ _l eri., co._ Water Meter Size 5/8"; 1"; $
State Surcharge $ (` l_ 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 $ j"2-r2-,.(c..z
This App ata Becomes Your Building Permit en Ap oved Paid jZ �i� Receipt No. 'i p
Date / _�� By 0--Bt { OfficialDate.
This is to certi that t e request in the above application and aecompanyi g docum is is in accordance with the City Zoning Ordinance and may proceed as requested. Thi:;document
when signed b"the t y Planner cwgntutes a temporary Certificate of Zo ing com lance and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued. I
" " - �- 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
DEPA
TMENT OF
PRIOR LAKE BUILDRNG AND INSPECTION
INSPECTION
RECORD ._1
SITE ADDRESS ‘(oC RNG.1.a
TYPE OF WORK
USE OF BUILDING F-.GS ff P _
PERMIT NO. o� , DATE/� ISSUED `('/Z6�3 _
BUILDER FR�c7 `17��IN K- L.eY•)sT PHONE # _
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FOOTING \16z,r-i F-e947r,:.k_ I J
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
*MK& 1
FINAL 7 I 3)5k
FOR ALL INSPECTIONS (952) 447-9850