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te. CITY OF PRILIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE q
x AND UTITY CONNECTION PERMIT £/./(
trj 11
4iNNESdcr I. Whe
2. PinkCity PERMIT NO. i l /
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS t ZONING(office use)
1 (°0 - 'e3rDititeCin 616 / — X-1sP
LEGAL DESCRIPTION(office use only) det //��
LOT BLOCK ADDITION PID '� -(,,�
OWNER
(Name) fJ e 15 Hc1c1 in s LLL (Phone) C-a 1Z-`ikeS- I ci99
(Address) LII)La i3 r oL O - r,on 13)vci Ne P i to L c\z e
BUILDER `r
(Company Name) V e' I V( hoc' e E-:/-tr KG s'S LL_c (Phone) 15 Z.1.Z0 `3C1 S
(Contact Name) (4'ytd (\\11t (Phone) 92.0--'d20-SgSe7
(Address) I LtIS 131-LiN;v„.,‘4.1C Ave ' S- o ',S Pci \
TYPE OF WORK ❑New Construction PKecic ❑Porch ORe-Roofing ❑Re-Siding ['Lower Level Finish 0 Fireplace
['Addition ['Alteration OUtility Connection
CODE: ❑I.R.C. ❑I.B.C. 0 Misc.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ CD �C=
Occupancy Group: A B E F H I M R S U I
(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 erp mint for just cause more,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
tature Contractor's License No. Date
Permit Valuation 0 Park Support Fee # $
Permit Fee $ 1 08 .Z.5" SAC # $
Plan Check Fee $ ,..s-----7 3‘.., Water Meter Size 5/8"; I"; $
State Surcharge $ /.- 5----0 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 / •
$ /47. i /
This Appli ,4 Becj' es Your B ding Permit When • �prov . Paid 14-'G ' - •fpt No. i�
i,�//fi� �` "t r Date .9,7 !'r I :r' ,
4ill, /_ ...r/
Bu`itrig o • DAV ill
This is to certify that the •st in e above application and accompanying documents i•in accord ce with the City Zoning Ordinance and may proceed as requested. This document
when signed by the Cit t/SQ er. 46tttAutes a temporary Certificate of Zoning complia c and al s construction to commence. Before occupancy,a Certificate of Occupancy must be
.40
issued. 1
?1 , -
Plann g `•ect. Date Special Conditions,if any
24 hour notice for all inspections(952)447-9850
- 4646 Dakota Street Prior Lake,MN 55372
PRIORLAKE AND B IMD NG INSP CITIO S'NG
INSPECTION
RECORD
SITE ADDRESS 41 /wCl6t`fM' LV,D
TYPE OF WORK tO&Z/L
USE OF BUILDING {w A�f2-
PERMIT NO. A3-,/aS/ DATE ISSUED 6-7
BUILDER !/MiUCi /--/e04er aLr? LCU/Cd' PHONE #
wsr o�re
I FOOTING td �- I I ? �'l,/ I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
1110311011
FINAL
FOR ALL INSPECTIONS (952) 447-9850