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0/�pRCITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
4/ `: TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
�' AND UTILITY CONNECTION PERMIT ` (4� /
jr`.-
NNES
i Z` 301 1.white File 2. Pink City PERMIT NO. /Z &()2._
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
37/ - Ao•,Ji-e At-rr ,1-1.4J/ / ?c,'damZ-kke /lamJS372
LEGAL DESCRIPTION(office use only) ,
LOT BLOCK ADDITION PID
OWNER
(Name) ,V#/1-cc/ fi /5e h a of d/tie,( (Phone) 1 02-.2'la- act??
(Address)2 7/)- A ,st/c AQ..rf /(Jr £A,:,,,-.Lcte e 1Y/AJ j ?• ...
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction PliDeck ['Porch ORe-Roofing ORe-Siding ['Lower Level Finish 0 Fireplace
['Addition ['Alteration ['Utility Connection
CODE: (1► .R.C. ❑I.B.C. 0 Misc:
Type o Cons 4 .ction: I II III IV V AB
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $
Division: 1 2 3 4 5 (excluding land)
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 bailding
official can rev e this permit for just use. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x G//5'l a 2._
Signature Contractor's License No. Date
Permit Valuation lir Q6 0) t) � Park Support Fee # $
Permit Fee $ 73 _7 5 SAC # $
Plan Check Fee $ 41, G/4- Water Meter Size 5/8";1"; $
State Surcharge $ / , (1 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 DUEbk,+ueutk it I tz, $ /a z _ 7
This A A.AI
i:ti I Becomes Your Building Permit ' . . Appro ed Paid /j 7 jj Receipt No. /2• 66Lp' a r Z Date 4// Z- By -3-6,i
:ui I ing Official Dat e
This is to :"'th. they. in the above application and accompanying docu ents is' accordance with the City Zoning Ordinance and may proceed as requested. This document
when signe.1 .- i //ann, constitutes a temporary Certificate of Zoning plian and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued.
Planning 1 irec n ate Special Conditions,if any
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
DEPA
TMENT OF
PRIOR LAKE BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS 37/Zrmri'S
TYPE OF WORK
USE OF BUILDING /ri
PERMIT NO. Z DATE ISSUED IS. IZ
BUILDER • PHONE #
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELID
THE PERMIT IS BY SEPARATE DOCUMENT
FOOTING �
INSPECTOR DATE
�,.
DATEDATE`a
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN IGNED
FINAL I Pb �2)/c>/
FOR ALL INSPECTIONS (952) 447-9850