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o� rx/oR CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
tri AND UTILITY CONNECTION PERMIT
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2. Pink City PERMIT NO. /6- 54
3 Yellow Applicant (//.��...•JJ
(Please type or print and sign at bottom)
ADDRESS 3 ZZC M APLCOA ZONING(office use)
ea.(on- ct✓ 1-1N Sc372 lie
I
LEGAL DESCRIPTION(office use only) ,�L� � ( /1i
LOT ) BLOCK ADDITION/1"k - W ���/A` "-' /ll� PID L - 7 72-® 5--O
OWNER �° /1 Pn An (A)LI Ai lit 3c�6 2-Sq—C3
(Name) C.T"/�' �� 1'‘/"� (Phone)
(Address) AS A-6 ve
BUILDER
(Company Name) (Phone)
(Contact Name)
(Address)
TYPE OF WORK 0 New Construction Nrrea ['Porch ❑Re-Roofing ❑Re-Siding ['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 BPROJECT COST/VALUE $ 4-50 D
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5 l
I hereby certify that • ye 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-mention . prope 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 re oke thi .ermit f. just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X Signature Contractor's License No. Date
Permit Valuation 0 00.6 6 Park Support Fee # $
/
Permit Fee $ 0 zg SAC # $
Plan Check Fee $ 57. 3c Water Meter Size 5/8"; 1"; $
State Surcharge $ ` 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'' / $ /, 'j- / /
This 'cation Becomes Your Building Permit When Approved Paid 14-4,' Receipt !¢
Date Z?_r;s By
e2e•—zet
Building Official Date
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
4646 Dakota Street Prior Lake,MN 55372
F
PRIOR LAKE BUILDRNG A D�NSPECTfON
INSPECTION
RECORD
SITE ADDRESS 32Z4 riAwe- Dz. •
TYPE OF WORK We"'
USE OF BUILDING RES it`K
PERMIT NO. /3. 5 4 0 DATE ISSUED S. Z� 7 14gBUILDER ,ec}WuNsow PHONE N400. 3(4. 2460
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FOOTING I ---t_
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
*MA I I
I
I FINAL
FOR ALL INSPECTIONS (952) 447-9850