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s,F PRio+ CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
A. t• TEMPORARY CERTIFICATE OF ZONING COMPLIANCE . 2 l
m AND UTILITY CONNECTION PERMIT
kiNN6S0it' I. white Pile PERMIT NO. ' _
2. Pink City /�K fP
3 Yellow ApplicantI `�
(Please type or print and sign at bottom)
ADDRESS t Cos—etrr �
IJ �✓t� p(e� ZONING('(officeuw)
/CAW
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID 2---S—, 4 a 64..0
OWNER
I }- (,
(Name) v W 4 �h S (Phone)
(Address)
1 BUILDER �^ ^^'t1om�
(Company Name) Fr4n 4,k. J—ylailf p0yei (Phone) so) z_9/ C.6 p.r
(Contact Name) -6414 F,ry 2 (Phone)
(Address) 332.2.- t uirc.L /14,t,t/ VZ b 1'`'�- /,
TYPE OF WORK El New Construction ZlPeck ❑Porch ❑Re-Roofing ❑RevSiding ['Lower Level Finish ❑Fireplace
❑Addition ['Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑Misc.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ •
Occupancy Group: ABE F HI MR SU
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 building
official can revoke t per for just cause Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X /- 63 7 2.;-Z, z-2_6-ks
Signature Contractor's License No. Date
Permit Valuation .3,U d v 06 Park Support Fee # $
Permit Fee $ --" SAC #k $
Plan Check Fee $ Sl 3/ Water Meter Size 5/8"; 1"; $
State Surcharge $ / ..CD 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 1:2 3-27,15" $ /47, / /
F
This App f atiI Be Imes Your Building Permit Wh: Appri ed Paid / Z„//" Rec t No. giT
C. � 3 z /3 Date ,74... By
Building Official Date
This is to cert/ `at th •,..quest.in the above application and accompanying docum. is is in ac..rdance with the City Zoning Ordinance and may proceed as requested. This document
when signed• Cit annex c . ' a temporary Certificate of Zoning co,.liance an.allows construction to commence. Before occupancy,a Ccitt icate of Occupancy must be
issued.
r 4--s ...i....,,- -""111114.11
Planning Director Pat: Special Conditions,if any
24 hou otice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372
DEPATMENT
F
PRIOR LAKE BUILDRNG A DOINSPECTION
INSPECTION
RECORD
SITE ADDRESS /GM/ 8I ,I/-W,OO MS'
TYPE OF WORK DEM
USE OF BUILDING
PERMIT NO.*.fAIaJt
/4: 256 DAT ISSUED a. Z . I S
BUILDER , // 16, PHONE # 2,9I,
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR ITE FOOTING I p�- I Cc��( Is
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I I
FINAL IJ�-c<.—. I /o/IS-Pr
FOR ALL INSPECTIONS (952) 447-9850