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p4 PR/p� CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
,� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
/49/e/(-
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400vEsOlt. I. White File PERMIT NO. !
2. pink City `� f
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3 Yellow Applicant f / GG...��
(Please type or print and sign at bottom)
SS
ADD ZONING(office use)
"5 cQ9 Poi This- Tit No
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER f'UPJ ' 1 (.)/\ \[ -- (Phone) 7SA eiSCA 0(0
(Address) b, C
BUILDER �n (Phone) l S g\ `'t 1 p� 7 0
(Company Name) �1 e"\�'v�s�S��`�' �tl.�.�rl��M �� Phone
(Contact Name)i `•- "t'�' .010, T--6-1/2.f o ( i yn p (Phone)
(Address) t)•-9A I 1 S 1 C r 1 Ut►C V 1 tG--
TYPE OF WORK ❑New Constn ['Deck ❑Porch ❑Re-Roofing [Me-Siding ❑Lower Level Finish ❑Fireplace
[' o
Addition ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑Misc. m®
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ I C5 Oa
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have fitrnished 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 propel- and that al construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
offici can revoke this,.+ fo - °u hermore,I hereby agree that the city official ora gnee may enter upon the pro to perform needed inspections.
, �����.�.- I &G�O
lop ���
Signature Contractor's License No. Date
Permit Valuation /VD' 02) Park Support Fee # $
Permit Fee $ d SAC # $
Plan Check Fee $ thlinEet6 Water Meter Size 5/8"; 1"; $
State Surcharge $ r CD Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $ 35" 25-
1
Gas Fireplace Permit Fee $ TOTAL DUE? $
This Application Becomes Your Building Permit When Approved Paid u 5, Z Recei No. 3`O O
Date /0, C, /5 By C, -- -
Building Official 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.
Planning Director Date Special Conditions,if any
24 hour notice for all inspections(952)447-9850
4646 Dakota Street Prior Lake,MN 55372
DEPARTMENT OF ENGINEERING
PRIOR LAKE AND BUILDING INSPECTIONS
INSPECTION
RECORD
SITE ADDRESS 350 Pej it_ 77u
TYPE OF WORK Ab0 BEDrcooti Ai tJ 7 661761—
USE OF BUILDING /e.&S h/,L
PERMIT NO. /5. /23G DATE ISSUED /0 -
BUILDER j/r'I,aeVes-72).-fE &ArizA7 PHONE # 4/Z - 786o
INSPECTOR DATE
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I FRAMING oe,-//r/v/cfre _ � &_,- � t tp 9 /y , I
P/n/f!-L_
FINAL / /3'it' I
FOR ALL INSPECTIONS (952) 447-9850