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�F FRi0 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
ye AND UTILITY CONNECTION PERMIT // t 2/►G
I. white File PERMIT NO. / -jr-)0
�--/
44,„E SOP 2. Pink City /
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
Leb6 tv s-5� ,*, ,,,_-2-5 -
LEGAL DESCRIPTION(office use only)
IGO3 .b
LOT BLOCK ADDITION PID ZS•
OWNER S j �O VO r K (Phone)
(Name) 1� �j �
"
(Address) /1460 i W�P1` 5T _ ,2i3
BUILDER I ' �N C-lO& (Phone) '7e 3- i"7 — 75 700
(Company Name) ` 'i'J F--
�{� 3(te\L2_�cS.� (Phone)-?'3-- Z33- z S I if
(Contact Name) l
(Address) ✓ Ric 11,l- -�'{- 7 ' " I �'('P 01/444,,, 'NM) SS-3 cY
TYPE OF WORK ❑New Construction liavck ❑Porch ❑Re-Roofing ['Re-Siding ❑Lower Level Finish ❑Fireplace
❑Addition ['Alteration ❑Utility Connection
CODE: 4: .' .C. D.B.C. LI Misc. � `�
Type of onstruction: I II III IV V A B PROJECT COST/VALUE $ OU
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5
I hereby certify tl,t 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-mentto. o 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 ca. oke this perm .r lust caus Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform need�t�p'ctions.
X V Date
/
Contractor's License No.
'ermit 'aluation l l3s/( Park Support Fee # $
Pe -sit lee $ 6-1+` W SAC # $
33 �� Water Meter Size 5/8"; 1"; $
Plan Check Fee $
State Surcharge $ S Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
DUE $ qcr
Gas Fireplace Permit Fee $ TOTAL �(�
tq0 •
/
W
This Application Becomes Your Building Permit hen Approved Paid t/. �� Receipt No.0 `
Date //' 21' /(-( BY � I
Building Official Date v`
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
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12' x 12'- (-. • ______ _
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APPROVED
Btiiiding7te Date 3/5 ----
Zoning__ Date
Grading ____ _ Date
F
PRIOR LAKEDEPARTMENT ULDNG A D�INSPECTION
INSPECTION
RECORD
SITE ADDRESS 4"&6,00 `#/ZZ"
TYPE OF WORK DC(./L -
USE OF BUILDING /2,e3
PERMIT NO. /S-- /12- DATE ISSUED Z- 46--4s
BUILDER f3'G/.67rn2- CONS . PHONE # 4/2-, 759. Q57
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
A'W
TE
FOOTING� � INSPECTOR p,t\, �`Ih�l�
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I FRAMING
I FINAL 412 `16-' J
FOR ALL INSPECTIONS (952) 447-9850