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fPRIpCITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
F TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 7J / _ 45-
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.. AND UTILITY CONNECTION PERMIT
yjH1VEs0st I. White File
2. Pink City PERMIT NO. /$ 74-Z
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER tccvsoit(Name) e (Phone)
(Address)
BUILDER
D(Company Name) ` I-M --1nC... (Phone) 5U? 1-7-R/ chc
(Contact Name) JC 1k1 F �k (Phone)
(Address) 5 EZ1_ �- C - Ale-C.,/ F et,t�
TYPE OF WORK ❑New Construction (}Peck EPorch DRe-Roofing ERe-Siding ❑Lower Level Finish ❑Fireplace
['Addition ❑Alteration ['Utility Connection
CODE: NP.R.C. ❑I.B.C. ❑Misc.
Type o o struction: I II III IV V A B PROJECT COST/VALUE $ Pt oCY12
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 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 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 this pe- it for just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X 6 37 -2- Z -7--/-/5
,- Signature Contractor's License No. Date
Permit Valuation 3, 0 a 0`0 d Park Support Fee # $
Permit Fee $ g g.1+ SAC # $
LI
Plan Check Fee $ 5) 3(0 Water Meter Size 5/8"; 1"; $
IState 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 $ (9'1
This Ap cat't Becomes Your Building Permit n A roved,<--. Paid / ��''` ! R rpt No. .i 'T e
hi Date i.. (.• 6r
ktir-^�
Bur u,i. Dat
This is to certify th t the request in the above application and accompanying docu nts i in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by,( 4'ty P temporary er constitutes a temporaCertificate of Zoning co dial-if•and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued. / j`
..- I
P-..... '•1 II'recto I ate Special Conditions,if any
— ..� 24 hour notice for all inspections(952)447-9850
4646 Dakota Street Prior Lake,MN 55372
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ADDRESS: A S �. /� /
PID: -----------
PERMIT
PERMRl1PE: / _ DATE INSPECTED: 7e/(e,------
.
ADDITIONS/BASEMENT FINISHES/PORCHES •
FLOOR COVERINGS:
Exterior Siding
Interior Wall covering
CEILING COVERINGS: •
HEATING:'
BATHROOMS: FULL: 3/4: 1/2: OTHER PLUMBING FIXTURES:
BEDROOMS tade:ion or bsmt only)# CABINETRY:
FIREPLACES: B Type
%OFTOTAL BASEMENT AREA FINISHED: Bsmt Fair Bsmt Avg BsmBeck
clt
OUTBUILDINGS
BUILDING STYLE:
FLOOR
WALLS:
' ROOF:
HEATED:
INSULATED:
FINISHED AREA:
OTHER/NOTES
PRIOR LAKE AND UI
BLD NG INS EC'TIO SING
INSPECTION
RECORD
SITE ADDRESS / 33 &6Arr/YOOQ PAss
TYPE OF WORK
USE OF BUILDING Dap.
PERMIT NO. /57 7•¢Z tDATE ISSUED 47• / , 1.5"
�,A/yE�[, �/Y�� PHONE # .,5-67 29/, 0692
INSPECTOR DATE
FOOTING I °�_ � � ( C( I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
WOW I I I
FINAL (
FOR ALL INSPECTIONS (952) 447-9850