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CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 5 Z 5 /Z_
.
AND UTILITY CONNECTION PERMIT
HEgp4�' I. While File PERMIT NO
2. Pink City /2.- 04'96
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
LIcg1 P (l ,,del ohtt... 56
LEGAL DESCRIPTION(office use only)
BLOCK ADDITION NOCt)1L.,(,D( . - `1Y $ PID
OWNER -DA' � `Cf
(Name) B t�11 V.Pert10% (Phone)
(Address) 4 Ikri,e04O' ' — C C , P(.0r LAI tib �537)
1 BUILDER
(Company Name) Nub 1 „fri (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK El New Construction YlDeck ❑Porch ORe-Roofing ORe-Siding ['Lower Level Finish ❑Fireplace
❑Addition ['Alteration ['Utility Connection
CODE: I.R.C.e ❑I.B.C. 0 Misc. �"
Type of Construction: I II III IV V A B •
PROJECT COST/VALUE $ ,'cue
Occupancy Group: ABE F HI MR SU
(excluding land)
Division: 1 2 3 4 5
I hereby certify that I have furnished information on t is 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 wt conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware� that the building
ffi
ocial can revoke thispermit for cause. ermo •I hereby agree that the city official or a designee may enter upon the property to perform neededr �
X inspections._
Signature Contractor's License No. Date
Permit Valuation4 J�,,c,..- -- Park Support Fee # $ '
Permit Fee $ SAC #
Plan Check Fee $ 6:6, IS Water Meter Size 5/8"; 1"; $
State Surcharge $ 2. — 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 e 5134 Z $ k-it . Is-
--1
This Appli tion B o es (t r Buildin_Permit When A ove Paid /7/_, e Rect fj. No. �jQ/�j
�.- �I s� 3d (Z Date 6 . C1. /Z By �.
Building Official Date /
This is to certify that •request a abo •application and accompanying document is in ac rdance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the y Pla erJ2tLwraiYce1ificateofZon1ntcomPh
cc and flows construction to commence. Before occupancy,a Certificate of Occupancy must he
issued.
(Z
Planning Director Date Special Conditions,if any
24 hour notic for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372
D
PRIOR LAKE BUP DRNG A D01 NF
SPECTION
INSPECTION
RECORD
SITE ADDRESS 450 E P /z
TYPE OF WORK
USE OF BUILDING / 3R//'--
PERMIT NO. ! Z . 4-162 DATE ISSUED 5: Z y- �4
BUILDER k416-2J/ PHONE # Z�� , 3 -Yo, gzzr
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FOOTING tAr.5
PLACE NO CONCRETE UNTIL ABOVE HA BEEN SIGNED
I
( FlNAL
•
• FOR ALL INSPECTIONS (952) 447-9850