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of PRI��P CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 9 -/. 15
., x AND UTILITY CONNECTION PERMIT
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4/MNEsolr I. white File PERMIT NO. /OW
3 pink City ��,
3 Yellow Applicant
(Please type or print and sign at bottom) • '
ADDRESS ) �,,k 1 QVN i vl P,gGe ZONING(office use)
PCieac Le Vz MN �`�3?? .
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) r'-f1 jO V\ --36•C' ‘f==. (Phone) Co IZ cl g"VGa-7
(Address) 1 eo ti 2S T°,L.,Ake p 1. t-1"O
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
//
TYPE OF WORK CI New Construction i/Deck ❑Porch ❑Re-Roofing ❑Re-Siding ['Lower Level Finish ❑Fireplace
['Addition ['Alteration ['Utility Connection i
CODE: R.C. ❑I.B.C. ❑Misc.
Type of Lonstruction: I II III IV V A B PROJECT COST/VALUE $
Occupancy Group: A B E F H I M R S U (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• t cause Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X V Ct-�'C' 9_ (_ I
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Signature Contractor's License No. Date
Permit Valuation 3, G 0 0, 0 0 Park Support Fee # $
Permit Fee $ e 8 - as SAC # $
Plan Check Fee $ 57 ,3 (o Water Meter Size 5/8"; 1"; $
State Surcharge $ / 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 $ /.77 !/
This • ` is i to Becooltes Your Building Permit en 'pproved Paid /1-7r// R ipt No. 4-7
i Date q_ /. /
. inu Ofticial Late
This is to certify that the request in the above application and accompanying do,Ime is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when sign/ %t , ity Planner const Utes a temporary Certificate of Zoning omp nee and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued
.Ndlik I
'arming Director Date Special Conditions,if any
24 hour notice for all inspections(952)447-9850
4646 Dakota Street Prior Lake,MN 55372
PRIORLAKE AND UIMD NG INSPECTIONS
INSPECTION
RECORD
SITE ADDRESS 16'!/g 7M-frnk-13 /L,q-e,&--
TYPE OF WORK /Je"ZK-
USE OF BUILDING /661 /VA-
PERMIT NO. /5- • /036 DATE ISSUED q-
BUILDER /Zl'R-h/ �11 N.O(js PHONE # 6,/ z. z4g'. re0Z7
INSPECTOR DATE
FOOTING I 7pJ�"
is
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
*MP I I I
( FINAL I /116 I /rJ/>2-,/
FOR ALL INSPECTIONS (952) 447-9850