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of PR/0 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 6(l 3 / 5
AND UTILITY CONNECTION PERMIT J
4WvNESee' 1. White File PERMIT NO. \2. Pink City 591
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 �-
(Name) `-' �–tig, )4-4-1--
R`j °4 1- l/` A S p 9-7 (Phone) ?-572.- a9 a -e a is-
(Address) "4%? , $Iv-44)y 8_,�,Z,- / � - l
BUILDER c�
(Company Name) (Phone) g� a`A— A--cg IS'
(Contact Name)
(Phone)
(Address)
TYPE OF WORK ❑New Construction Wed( ['Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish (21 Fireplace
❑Utili Connection
CODE: ❑I.R.C. ❑I.B.C. ❑Misc.
Type of Construction: I II I IV A B
PROJECT COST/VALUE $ AD6� Q�?
Occupancy Group: A B E H I M R SU
Division: 1 /t 4 5 (excluding land)
—.NOV Id
I hereby certify that I ha • Wished inf •-r n • 'application -'o the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above-mentioned •-;.erty and that al .. e';00,.•1 con• o all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can rev e this permit for)u -, hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
-- 466 .3=f3- av/S_'
Contractor's License No. Date
Permit Valuation 1 sne)o `6 Park Support Fee #
Permit Fee $ 57O SAC # $
Plan Check Fee $ 37, 3S' Water Meter Size 5/8"; 1"; $
State Surcharge $ _ 7 5 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 &ite"eb .5-i i r i5-- $ 95. 65
This Application Becomes Your Building Permit When Approved Paid 95. 6'3peib
/iPtNo.(Diz
jely n Date S„/1. iS
Building Official Dat
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,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372
PRIOR LAKE
SITE ADDRESS
•
TYPE OF WORK
DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
R C RD
j,�1 /� I,,,�
;Ls
USE OF BUILDINGA. ',
PERMIT NO. I T DA E ISSUED
BUILDER 47,;911j _•! 'i.,k PHONE # WS°
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTI NS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPE OR
JFOOnNG VC I c DATE
' `�
I
PLACE NO CONCRETE UNT I
IL ABOVE HAS BEEN SIGNED
I FRAMING I
/ I
I FINAL I Pt/ I 124//�
FOR ALL INSPECTIONS (952) 447-9850