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of p�o,� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
.4 . . TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMITtv
/54'IHNa$01' I. White Fife
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2. pink city I PERMIT NO. `S #z,...3 I
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
-`S l ( n 0 1-`� S 2.,e -)(lJ '1 1\;+? 1- .
424
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID t 4-10S-- 001- 0
o
(Nao� -ti'Kt\\..t l v-'C\r.\o-cfce e, (Phone) (1 z� '' '' i \ 4'\`J
(Address) 3 (,. ( 1 "1 G l Y'.,Q t Cit.� CG'KN ",k- ?+Z„ ,c' Le-4Q Le-4Q \ k S S '---) `Z,
BUILDER
(Company Name) NI lig' (Phone) CA S.). --)—W-410
(Contact Name) 73---c -_--i- Kr;til/ 1 e,v'-” \O:•i►Yv (Phone) 7)-1-14 b -- c G'
(Address) 33
� e•. i ''�
, ( J I 1'1 rd 1�Y1 -moi Jwu i r,... ..t_., L(Q 1,,,Ah.1 s -1 2._
TYPE OF WORK ❑New Construction is Deck ❑Porch °Re-Roofing ORe-Siding ❑Lower Level Finish 0 Fireplace
[IAddition ❑Alteration ❑Utility Connection
CODE: .R.C. I.B.C. 0 Misc.
Type of C struction: I II III IV V A B
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $
Division: 1 2 3 4 5 (excluding land)
I hereby certify that 1 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 permit for justtca . �Furth/e�rmore,I hereby agree that the city official or a designee may enter upon the property to perform needed
tnspecho s.
\,, Signature Contractor's License No.
Date
Permit Valuation 006 00 Park Support Fee # $
Permit Fee $ /03 - 0 U SAC # $
Plan Check Fee $ 6 4 /'S-- Water Meter Size 5/8"; 1"; $
State Surcharge $ ,Z ,G 6 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 A�'ca,t n B owes Your Building Permit , A proved Paid / --�,0
�• � Recei t No. {^f�
i�� Date ---(p /S-- BY r
A,_ C
•uddin--T„,----_---cial `�� Oat.
This is to certify 'at the request in the above application and accompanying docu • nts' n accordance with the CityZoningOrdinance and may
when signed b`•e C,a/Planner constitutes a temporary Certificate of Zoning co•plia c and allows construction t commence. Before occupancy,ya ed orequested. This documenttbe
issued. / 1 a Certificate of Occupancy must be
• it�� Ic
f Date
Special Conditions,if any
24 hour notice for all inspections(952)447-9850
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4646 Dakota Street Prior Lake,MN 55372 t
PRIOR LAKE BUILDING A DOINSPECTION
INSPECTION
�
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SITE ADDRESS 0013
91: 41$171VP
TYPE OF WORK J�J
USE OF BUILDIN � _1l � Al"PERMIT NO. �'�'h DATE ISSUED
674511BUILDER -j L sr, IPHONE #�'� O
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
IFOO7ING I L'�-� I 9I‘°l6- I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
IFINAL
FOR ALL INSPECTIONS (952) 447-9850