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ot.,fPi% CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ig i�e1 AND UTILITY CONNECTION PERMIT °
'y0,NEsotr' i. white File PERMIT NO.
2. Pink City /5,5-6,3
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
Z Coe 1 3Q-OC KE*, CT. , 1'rt_t ID n— /..._tai tc,r, , nn IN) 5'"-tts--12
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID ZS_ 4- .b 64' 0
(Name) ..
Oe C[1-0 FOOT (Phone) Ci --"L 2.4..4 t] 31 %I
(Address) %6cr,k rz_oet-*c t...) c f P2 t o ez., CIA tce- Wk.) NsS-1 Z
BUILDER
(Company Name) (Phone) ----
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑New Construction aDeck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish 0 Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: I4I.R.C. ❑I.B.C. ❑Misc.
Type of Construction: I II ID IV V A B PROJECT COST/VALUE $ S 200 on
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5
1 hereby certi at I h e fumishe. formation this applicat'.n 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-mcn ned prop and t all onstru .on will conf. -to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
:cfficial c revoke th' permit'.r just cause. -hermo�by agree that the city official or a designee may enter upon the property to perform needed inspections.
- ✓
ign. Contractor's License No. ate
Permit Valuation 46W - Park Support Fee # $
Permit Fee $
(6177— — SAC # $
Plan Check Fee $ 647 , g C 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 $ (1‘ ,15
/�7r?This App 'on ;• o , o Building Permit n Appr ed Paid R eipt No. /32....Z__
�� I �" �,_ Date ✓r��f (5'
lA.. ', 61, .'
Building Ofti is.' Date
This is to cern hat the r ucst int a above application and accompanying documen in ace dance with the City Zoning Ordinance and may proceed as requested. This document
when signed the ity n . strtutes a temporary Certificate of Zoning compli cc and lows construction to commence. Before )ccupancy,a Certificate of Occupancy must be
issued. /�
A r` / —
P1 i : ti r 111111 D.te Special Conditions,if any
24 hour notice for all inspections(952)447-9850
4646 Dakota Street Prior Lake,MN 55372
D
F
PRIOR LAKE BUILDING A D�INSPECTION
INSPECTION
RECORD
SITE ADDRESS 3 &ca aze eg,e--xJ
TYPE OF WORK De-6g--
USE OF BUILDING Rill '`ipt-
PERMIT NO. /S51Y7 DATE ISSUED S. I 1. 1S--
BUILDER
rBUILDER eift,o F0 OT PHONE # q3Z, Z9a. 30/
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FOOTING (ek231
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
FRAMING
I FINAL 4 H Nr
FOR ALL INSPECTIONS (952) 447-9850