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of PR�3 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE - j-- ZJ. l 3J
py AND UTILITY CONNECTION PERMIT
4--HxesoSh Wh2 Pink e.Y PERMIT NO. L/�f-
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
22 7 -/�-7() , )c*,
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER ,1 / (D "Z 3.7 6 o
(Name) 4V /C i e /JG'..,e' (Phone)
(Address)
BUILDER
(Company Name) ,// $c'4'50 45 (Phone) 9.,c.z- 73"C 3-' ,C3S
(Contact Name) ,/:-:y 4, " j�acJe•-i (Phone)
(Address) /�,2.27; .�V!o /41 itlei 1-
TYPE OF WORK 0 New Construction ,'Neck ❑Porch ORe-Roofing ORe-Siding ❑Lower Level Finish 0 Fireplace
❑Addition DAlteratio DUtility Connection
CODE:AkR.C. DI.B.C. 0 Misc.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $
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. nstruction 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 jus ause. Furthermore,I herby•' e that the city official or a designee may enter upon the property to perform needed inspections-
x �!�.." ��.� /SCS""7DUiS /
Signature Contractor's License No. Date
Permit Valuatiop,ek ' / Park Support Fee # $
Permit Fee $ -, SAC # $
cb
Plan Check Fee $ jWater Meter Size 5/8"; I"; $
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 1 �// $
Gas Fireplace Permit Fee $ TOTAL DUE G .,Q j,2-3-(3 $ Zit• J, 3
This Appi' n 'I omes Your Building Permit When •pprove Paid 2 Z /• C.,R ipt No. g(Z,
,/ ` Date G .c/ i3
, Avow
B .'fline Officia Di te
This is to certify that the re. •-t in t e a ve application and accompanying documents is in a. ordance ith the City Zoning Ordinance and may proceed as requested. This document
when signed by the City P ii co ties
es a temporary Certificate of Zoning compliance a i allows c struction to commence. Before occupancy,a Certificate of Occupancy must be
issued. .
Plannin' .- or D:te Special Conditions,if any
4 hou otice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372
D
F
PRIOR LAKE BUI DRNG D�INSPECTION
INSPECTION
SITE ADDRESS
RECORD
01c.•
TYPE OF WORK ire yUSE OF BUILDING IM//s..
PERMIT NO. 13, 4dif, DATE ISSUED C. 2,1• /3
BUILDER nLL SQtSt/vS PHONE # 7.34. 3306
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
IFOO11NG I fly -�9�,3 �
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
*POW I I I
I FINAL Lae -- I B J 7A- /
FOR ALL INSPECTIONS (952) 447-9850