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F PRlo CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,p, Rec d
a TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
= m AND UTILITY CONNECTION PERMIT �� ��
U
/3.L2b
447,ese° 1. White Fay PERMIT NO. u
3 pink City /�/j
(Please3 Yellow Applicant �`/�J
type or print and sign at bottom)
ADDRESS ZONING(office use)
3a I I mc&ptt (Jr 5W ,c,i
LEGAL DESCRIPTION(office use only)
LOT.1 BLOCK Z— ADDITION ti/VP(/67 (.( PIDz 5, 4fe,_ 6/2- - O
OWNER ,p JJ f /
(Name) ill I�n 4 e0 I�f t N ko f' (Phone) 316- b yo_ 6 //5-
(Address)
/5(Address) 3a lei rno•t or Su Prior 1...u.k t 55312_ _
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction eek ❑Porch ❑Re-Roofing ORe-Siding GLower Level Finish ❑Fireplace
DAddition ❑Alteration ❑Utility Connection
CODE: r)i.R.C. ❑LB.C, 0 Misc.
Type of gnsty Group:
uction: I II III IV V A B PROJECT COST/VALUE $ $ LOCO-
Occupancy GrA B E F HI MR SU (excluding land)
Division: I 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 agent for the
above-mentioned pro rty 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 c re oke permit for Just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed mspcctions.
X 5-19-IS
Signature Contractor's License No. Date
Permit Valuation3� 0 0 Q„ vca Park Support Fee # $
Permit Fee $ 8 2,5 SAC # $
Plan Check Fee $ �7 36 Water Meter Size 5/8"; 1"; $
State Surcharge $ f 1-7.) 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 $ (If 7 ! ( '
This Appi,, 'o co s Your Building Permit Wh . •ppro d Paid ill,I p
j Re ipt No. IOC
,I 1('W /,5 r. Date ¶1 ( ,/s' B
s uilding Official Date
This is to cern. hat rcqu'tin the above application and accompanying docu nts is in ccordance with the City Zoning Ordinance and may proceed as requested. This document
when Signe. e I iv tutes a temporary Certificate of Zoning co .fiance, d allows construction to commence. Before occupancy,a Certtticate of Occupancy must be
issued. i
Planning a l'te Special Conditions,if any
24 hour notice for all inspections(952)447-9850
4646 Dakota Street Prior Lake,MN 55372
DEPATMENT
PRIOR LAKE BUILDING A D�INSPECTION
INSPECTION
RECORD
SITE ADDRESS 32/9' 111424,E O/L.
TYPE OF WORK
USE OF BUILDING ICt-3 l9/11—
PERMIT NO. /5--.49. DATE ISSUED C. /5 . Is"
BUILDER LOQ PHONE # 4g8
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DATE
INSPECTOR FOOTING I �— L312.37 1 6—
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I FINAL
FOR ALL INSPECTIONS (952) 447-9850