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PRic CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
(op t. CERTIFICATE OF ZONING COMPLIANCE 10. IS ,
10/
i. AND UTILITY CONNECTION PERMIT
U en
PAS Ak,
M,A'NEs.:0 i. White File
2. Pink City PERMIT NO. l0 1053
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESSZONING(office use)
H 0t,,,A44/-0 -)
7o . ,�DGS C. (2((_& z, sD
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID ZS. 032 , 0 22.1
OWNER
(Name) 3-AcC(Ct it A.5,)--i lc, (Phone)
(Address)
BUILDER
(Company Name) �.rte* M1.S C v S""a 7"1 •M ':$ (Phone)# & (Z -Z 2 t — Z?t 5
(Contact Name) S -,./ ^02E- (Phone)
(Address) I (7 Z _ l EP P-06-r Lt- kill I 1:V00113.,..u- / r1 J
TYPE OF WORK ❑New Construction ;beck ❑Porch EIRe-Roofing EIRe-Siding ❑Lower Level Finish El Fireplace
-ikaddition DAlteration ❑Utility Connection
CODE: l..C. ❑I.B.C. El 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 t
I hereby certify that I have furtiisheftinformation op.tl+i7plication 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 constru'ttion will opfo 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 foriust cause. Further.,e,I her agree that the city official or a designee may enter upon the property to perform needed inspections.
� , -/ Contractor's License No. Date
Permit Vat l., n 1 0 00 Park Support Fee # $
Permit Fee $ k , z.g SAC # $
Plan Check Fee $ 15.1 I Water Meter Size 5/8"; 1"; $
State Surcharge $ 3. 50 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 iptNo.
$ ' `o�
A O'A(..LeD �ltg io
Thi ( iii Becomes 't.. :uilding Permit en App oved Paid -1,11,. fZ� • T 6/6 7 9
, r ' l/ Date //. /(a , /6 :,
�/ ( I 15 ►v
uil Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued.
/ : ping Director 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 r.r.,
SITE ADDRESS e=.- e, zko Ca-e..L`
TYPE OF WORK
USE OF BUILDING .a 4._
PERMIT NO. ( 0 . (053 pATE ISSUED 1).4?(L.S4
BUILDER -(•\ o tt -S t PHONE # (0. (7. .21.1_ zL s-
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BYS PA ATE DOCUMENT
useik(� Ls` O? I/7/7/es INSPECTOR DATE
FOOTING PO 1/7 ,
7,
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
OMER /
I FINAL 4 cbt hp
FOR ALL INSPECTIONS (952) 447-9850