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6CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT - Ze-!s-
1. White File PERMIT NO.
2. Pink City. �"Ji`/
(Please type or print and sign at bottom) 3. Yellow Applicant //(�
ADDRESS ZONING(office use)
LILN 1/1ev/ ( SE
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PH)
OWNE
(Name) To On 13a-tC•S (Phone) 952- y L G - 01 U
(Address) 443 1 Rind V ',') TV U SE p vr1�Y' ILC M N 55 312
BUILDER
(Company Name) rd a Rci NADGAtA InC1 LL (Phone)
(Contact Name) 1 CAd C-, a.rd a (Phone)952-2-6) - 3208
(Address) -1)1 Sr . U\ 3Q\/o e NA ki 5 --1
TYPE OF WORK 0 New Construction Deck ['Porch ORe-Roofing ORe-Siding ['Lower Level Finish 0 Fire e
['Addition ['Alteration ['Utility Connection
CODE: .R.C. DI.B.C. 0 Misc:
Type of instruction: I II III IV V A B
Occupancy Group: A B E F H I M R SU PROJECT COST/VALUE $ 7000 '
60
Division: 1 2 3 4 5 (excluding land)
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 permit for just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X C3 P5/ —z- —/--- --
Signature Contractor's License No. ate
P 't Valuation .v.. .",7,0. ...„7--1Park Support Fee # $
Permit Fee $ 4i}3y— SAC # $
%
Plan Check Fee $ ( a Water Meter Size 5/8"; 1"; $
/$
State Surcharge $ / 7 _ Pressure Reducer $
Penalty $ rJfJ
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 $ I.4i�'.
/ 1
This App 'o' comes Youff3uilding Permit When •pprove. Paid f/7 6 4 . Re ipt No. /9#7I
.i Date , ?„..5 c CS Y
4 ' ,e
Building O- :. Da-
-
This is to certify that the -qu- 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 th i ' consti�rtes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued. , pr
4,�� 1
PI: r• g Director -.4.� Date Special Conditions,if any
24 Trill : e for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
PRl0R 'LAKE
AND BUILDIDEPARTMENTNG OFINSPEGINECTIOENERINGNS
INSPECTION
RECORD
SITE ADDRESS ; u• Mar
TYPE OF WORK
USE OF BUILDIN f j ,/A:
PERMIT NO. �
BUILDER A .,71 e DAT ISSUED arAri
•
�i � .f `/. e40•
PHONE # e24
FOOTING INSPECTOR
DATE
PLACE NO CONCRETE UNTIL ABO
FRAMING VE HAS BEEN SIGNED
FINAL
FOR ALL INSPECTIONS (952) 447-9850