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of "ON, CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE i
AND UTILITY CONNECTION PERMITl5
~/ivNES.. t. White Fite
2. Pell city PERMIT NO.r !' �j
3 Yellow Applicant e I
(Please type or print and sign at bottom)
ADDRESS�[
A 404f i !4U G. `..Y
t✓ /u.e. • ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER"'�` a
(Name) J 0 S 0.0' S (Phone)
(Address) /' 2. (DLI M i-f 6 'C4 Cr Ni,
(Company �—�
Name) 04 JOoCJ (L �►tir s (Phone) 6,'D 75?L 2".57
(Contact Name) ( $NA. (41141
J + (Phone)
(Address) 9'9 (fg Nt. sf. G N H it'. ,57sa 2,
TYPE OF WORK 0 New Construction 717eck DPorch ORe-Roofing ORe-Siding DLower Level Finish 0 Fireplace
DAddition DAlteratton DUtility Connection
CODE: DI.R.C. DI.B.C. 0 Misc.
Type of Construction: I II III IV V A 13
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ (Pena O 0
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have famished 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-menti.- 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 ca evo this peva for just c. se. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed ins •ehons.
X
3C, 6 3 Sigel 7 r 3 c;)-6 l'
Signature ` Contractor's License No. Date
Permit Valuationz �`V 00 M 4 0 Park Support Fee ## $
Permit Fee
$ ✓J3w SAC ## $
Plan Check Fee $ 4-7, Water Meter Size 5/8"; 1"; $
State Surcharge $ I 0 V 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 $ C2z ,(
This Ap 'cati n Becomes Your Building Permit n A proved •
Paid (i, ,�� Rece' o. ` 041-
(1,7.-
4
�4 �
4 ' 8 3 (\� Date (j) 3 15 By
•wilding Official Date l
This is to certify that the request in the above application and accompanying documents is in Icor ce with the City Zoning Ordinance and may proceed as requested. This document
when signed by th• ity ' nner constitutes a temporary Certificate of Zoning compliance d a iws construction to commence. Before occupancy,a Certificate of Occupancy must be
issued.
e3ri--
Planning Director ate Special Conditions,if any
24 hour notice for all inspections(952)447-9850
4646 Dakota Street Prior Lake,MN 55372
PRIORLAKE ADEPNDA UILnNENT OF ENGDING INSP CITIO S'NG
- INSPECTION
RECORD
SITE ADDRESS /' 4ftu7OA t LC_
TYPE OF WORK
USE OF BUILDING
PERMIT NO. IS. ea/ DATE ISSUED S. 3 1s-
BUILDER ONC,NaeD edelanitakSpHONE # G/2 , 7504625,
INSPECTOR DATE
I FOOTING � lb I sJs�i�
PLACE NO CONCRETE UNTIL ABOVE H A BEEFN IGNED
IAMMMs 1
FINAL I j�3 18� //G- �
FOR ALL INSPECTIONS (952) 447-9850