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0 PRtp4, \l/"/I;5° CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
A ; ,l, ' TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT /0 t 4 t oft
U x
4,1Nxtaso'tt. I. White File PERMIT NO. /y,
perk City /
3
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
r70'7 3SkAi`kr' \&.E.-,..,„, e...b, / 5
LEGAL DESCRIPTION(office use only) ,
-j? .
LOT .BLOCK ADDITION,715 /, i2 v/e PID a75.-;?52 ac7 9-
OWNER46,
=
(Name) "T T C AVV‘-' SE-7-C.._“-FP-i- (Phone) WI ^-1 cZ .r C p,
?S-3
(Address) I s.-707 "rS LA-Ai 0 V 4.a t,(.) 2.1) (Ai
BUILDER A /�
(Company Name) C P Ai\ OO T `' (0/A5,1(. AVC-. (Phone) Cd qqo- 7(c
(Contact Name) U-614 A) C-4 P ft?O 04— e
(Phone) q - 4 Si 5e,
(Address) `j tic j - /.t3'Cw- sT, 6L-
TYPE OF WORK 0 New Construction ODeck ❑Porch ORe-Roofing rte-Siding ❑Lower Level Finish 0 Fire._ce
❑Addition .Alteration ❑Utility Connection t� �r�. _ fes,�' "lS-(�
CODE: .R.C. DI.B.C.
[tpMisc. L4 ,•J ) — -rY6 wt `-_ . ..0-
CODE:
•
Type of C nstruction: I II III IV V AB �--Av, ��
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ �t
(excluding land)
Division: 1 2 3 4 5
I hereby certify that I have famished 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 n rev e t ' ermit forst cause- Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ / i(,� 13 SAC, # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ v V Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ rya Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ 7pclr
riq
This Applic •' n :• omes Your Building Permit When Prov d P4)604-,V`'' [ Receipt No. �
�
�¢® 8 Dae /� ` / ,
By
..
1 f t�
Building Date
This is to cern., that the request in the above application and accompanying documents is actor ance with the City Zoning Ordinance and may proceed as requested. This document
when signed - ,he Plann•r constitutes a temporary Certificate of Zoning compliance nd al ws construction to commence. Before occupancy,a Certificate of Occupancy must be'
issued. ',Al
F Planning Directo\ 0 ate 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 LAKEDEPARTMENT UILD INA DOF
INSPECTION
INSPECTION
RECORD
SITE ADDRESS /5767 �.SC-el-AID !/1E1A7 �
TYPE OF WORK
USE OF BUILDING XES/f1L l•
PERMIT NO. /¢. lO87 DATE ISSUED 10 . !o . /F-
BUILDER en.Sfl/fOVf1 PHONE # (a/2-•�/4-6 .-7(Ofl
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
(?-) INSPECTOR DATE
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I FRAMING 3
FINAL 1 y )G- 3
FOR ALL INSPECTIONS (952) 447-9850