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OF PR-16 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
7 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
v AND UTILITY CONNECTION PERMIT 7. / ` (c----
4,..Eso, I. White File CP
2. Pink cPERMIT NO. /5 79�
3 Yellow Applicant
(Please type or print and sign at bottom) _
ADDRESS ZONING(office use)
I105 I S11 [-ant 5E.
R I
LEGAL DESCRIPTION(office use only)
LOT r BLOCK /d ADDITION ‘b----e/g...-g-&—g ?W S PID p?5 549-00'a
(Name)
C I"J/cZC\ (Phone) ('fla)a3q OO&3
(Address) I tp5LI I 51,i1 SJ'
BUILDER �_ �B , 1 / //�(��(
(Company Name)7R C, C3rr 1 it u(a. (Phone) Casa'lD b U Novy)
(Contact Name) b cevektr
y - (Phone)
(Address)_1'7Y3a 11 mer- ,{.�.�P_6v-e� /Seibi it I131Q, <50Y
TYPE OF WORK L 4tew Construction Week ❑Porch DRe-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace
DAddition DAlteration DUtility Connection
CODE II.R.C. ❑I.B.C. ❑Misc.
Type o onstruction: I II III IV V A B PROJECT COST/VALUE $ IC)i .a
Occupancy Group: ABE F HI MR SU ,
(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 permit for just eau Ft-thermore,I hereby agree that the city official or a designee may enter upon the property to perform needed i spections.
X.- .., l3zigosg 7.II3
Signature Contractor's License No. Date
Permit Valuation ,'.3 ®0p, Park Support Fee # $
Permit Fee $ e'•2-1C. SAC # $
Plan Check Fee $ 5-7''3P 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 ���� Q $
Gas Fireplace Permit Fee $ TOTAL DUE (q / Q) 7.9
is— J$ x(17.
This tic tion Becomel-Your Building Permit a Approved Paid I`f'1� I I Receipt No. o�at S
._ 7 6 /(c Date i. / . ( ByBt IdinOfficial D. e
This is to certi that the request intthe-above application and accompanying documem,is in ac'.rdance with the City Zoning Ordinance and may proceed as requested. This document
when signed e 'ty Planner constitutes a temporary Certificate of Zoning compli nee and'flows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued.
7 8
Date Special Conditions,if any
24 hour notice for all inspections(952)447-9850
4646 Dakota Street Prior Lake,MN 55372
l
PRIORLAKE AND UILADING INSPECTIONS
INSPECTION
RECORD
SITE ADDRESS A4,54-./ G4AI�
TYPE OF WORK /
USE OF BUILDING
PERMIT NO. /4C '� ! f 4-4,
BUILDER -0-"k - 6t) -DM
ISSUED -7. 6 . (5"-DM � PHONE # �8=/
FOOTING INSPECTORDATE
PLACE SSEIN
NO CONCRETE UNTIL HAS BEEN ED
FINAL
.yMININIIMMINSWMIam
FOR ALL INSPECTIONS (952) 447_9850