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"F PR/p CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Date Reed
lAND UTILITY CONNECTION PERMIT
1
411A'NES°P. 1 white File
2 Pini; City I PERMIT NO. //. /2„3/ I
(Please type or print and sign at bottom) 3 Yellow Applicant
ADDRESS
i ZONING(office use)
�� Z l J l�i�kA C j, 4) r v {SUS.)
LEGAL DESCRIPTION(office use only)
LOT 2,5-BLOCK 9 ADDITION b/t,t -c--5 df Afel t k woo cJ PID ?. l-�--%, Q(v(; 0
(Name)OWNER
\) A J e i L\A o
(Phone)
(Address) Com. T /? u i( ✓
BUILDER
(Company Name) i CACI- �'2x,n,,Ly (Phone) 7,,5- Z' %b g" 630o
(Contact Name) �v��
(Address) ►•t S 5 L.,',i2-c,7 P 4-fi a (Phone) 4 1 Z' Z- 7
I-76
TYPE OF WORK D New Construction (c!issis___Zkorcl )URe-Roofin
g ❑Re-Siding ❑Lower Level Finish 0 Fireplace
DAddition ❑Alteration
❑Utiliry-Connection
CODE: DLR.C. DI.B.C, D Misc.
Type of Construction: I II III IV V A B Fe
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ �(JGU
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 tate and correct. I also certify that I am the owner or authorized agent for the
above-mentioned property and that all constriction 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. ' .r just cause Furthermore,I hereby agree that the city official or a designee may enter upon the propertyto
perform needed inspections.
X _ _/iii63i/ 6N l/(-//
Signa u re
Contractor's License No. Date
Permit Valuation Park
Permit Fee ``�2-, e c-'c -,..)c i Support Fee # $
Z'2 /. K C SAC # $
Plan Check Fee $ Water Meter Size 5/8'; 1";
/4- .3. Cr $
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
$
Gas Fireplace Permit Fee $ TOTAL DUE
f l $ _3 7G%.(j`)
This j ication a r
4044A,650 ('t4 r t
•nes Your Building Permit Wil n A roved Paid 370. 6. d' ,L
R ipt No. /,7` 1
Date 7/..te, , </
4. . .�1.•.��. /r zi I( � .
Building Official 1"'"‘" Dale /
This is to certify that the,'equest/n the above application and accompanying doe eats' in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signs.ny the ity 'la na constitutes a temporary Certificate of Zoning ci plia a and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued , -
1I 4I Ir'
Planningct. -- Date
Special Conditions,if any
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372
•
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS /6 Z S/ H/i-'i 1 c i
TYPE OF WORK DE; G '' po/z,cH
USE OF BUILDING /eel. /--
PERMIT NO. `/. /Z3 OATE ISSUED
BUILDER tc7EZd(.5."--6e PHONE # 149_ Q 0
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSTR DATE
FOOTING //�i7i l
PLACE NO CONCRETE UNTIL ABO E HAS BEE SIGNED
FRAMING 'Q1c CH � � A. /
FINAL % 2,17 ) DeU2 -Pi'
11-a-,r'r-T-ff--1
FOR ALL INSPECTIONS (952) 447-9850