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o f PR: CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,� A�� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE j ��,�
I" A. AND UTILITY CONNECTION PERMIT (�
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+4,NEsolt- I. White File
2. Pink city PERMIT NO. /5"-, 657
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
SOU(' tr "00 IC r 6 i‘c i..,
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
e
OWNER �o
(Name) 6�1 f `—/� (Phone)
(Address) d
BUILDER ,
(Company Name) 4 - t rpt G4 'T NlUr fTf' ?,i -Lr'C (Phone) 64.1 .- Coo--6 t)2C
(Contact Name) „Al;s 6-e-is xArt (Phone)
(Address) i1 .7() G'J 4Kt-A T2 4 Or
TYPE OF WORK ❑New ConstructionDeck ❑Porch Eke-Roofing ['Re-Siding ❑Lower Level Finish ❑Fireplace
❑Addition ['Alter to ['Utility Connection
CODE: .R.C. ❑I.B.C. El Misc.
Type of onstruction: I II III IV V A B
Occupan Group: ABE F HI MR SU PROJECT COST/VALUE $
(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 propertyand 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 p mitlfor just c se Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed raspctions
X 71C 6 0.2_ 6 /(e 5r
Signature Contractor's License No. Date
Permit ValuationDo 0. 0 Park Support Fee # $
Z.
Permit Fee $ .7372 SAC # $
Plan Check Fee $ _!<,7 94„ Water Meter Size 5/8"; 1"; $
State Surcharge $ j u 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 D $ I a L,&
I - I
6# fjp
This Applica/'in 1;comes Your Building Permit Whe App oved Paid /22&77 Receipt o. /7
Date By fnL
Burd 0 Official ate
This is to certify that ere nest in the above application and accompanying documents in acro ance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the P. ner constitutes a temporary Certificate of Zoning complia e and ows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued • .."----
ann Date Special Conditions,if any
24 hour notice or all inspections(952)447-9850
4646 Dakota Street Prior Lake,MN 55372
DEPART
ENT
F
PRIOR LAKE AND BUIILD NGOINSP CITIO SING
INSPECTION
RECORD
SITE ADDRESS 523(4. BzoOIcS 6iiette
TYPE OF WORK DFiCK
USE OF BUILDING �.y QES A/iGb
/5:PERMIT NO. � G� / DATE ISSUED W. &. 15"P
BUILDER teA /P hNIfainENT PHONE # G/L. `GO. ea%
INSPECTOR DATE
FOOTING I I b`� �- ��
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
FRAMING
( FINAL I `]''_`- � '1 ,73l ` )--
• FOR ALL INSPECTIONS (952) 447-9850