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of PR/0 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
'1'
AND UTILITY CONNECTION PERMIT
�sNNESO�� �C %ti�/rT 7 ✓� Ar . 2-
'.-. . I. White File
6 s / - 6
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Apppiplicant (�/
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PERMIT NO f�� 0004"
(Please type or print and sign at bottom)
ADDRESS
ZONING(office use)
�l/aGS
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID z1i 0 2.4.,0
OWNER
(Name)
(Phone)
(Address)
BUILDER /�
(Company Na T✓ / p
�/.- (Phone) /2- 6. 6 �/5
(Contact Name)
(Phone)
(Address)
01� /
gC
TYPE OF WORK
El New Construction ❑Deck DPorch ❑Re-Roofing e-
Si ]Lowl Finish �❑Fireplac
['Addition DAlteration ❑Utility Connection `6� Y�/� ^, ,
CODE: ❑I.R.C. ❑I.B.C. ,7�/ .6!_��
Type of Construction: I II III IV V A Bt �� til UM C f
Occupancy Group: ABE F HI MR SU PR 3E COST/VAL $
Division: 1 2 3 4 5 4/, jeXc ual 7f,4-L 4 5/2, /7
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 construction 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 rev •this perm rjust cause. Further reby agree that the city official or a di. nee ma nter upon the property to perform need .--
d mspectio s.
Signature Contractor's License No. Da e
Permit Valuation 3/ 0 0 0 + 0 Park Support Fee # $
Permit Fee $ Z4 7` `> (.J SAC #p $
Plan Check Fee $ / Water Meter Size 5/8"; 1"; $
State Surcharge $ 5 Q Pressure Reducer $
Penalty $ l� 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 $ 2. a Q'0
This Application Becomes Your Building Permit When Approved Paid Z 4' �G2/ f
t No. s r
iZr
Date i'. LC, (
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
•
DEPAR
ENT
OF
RIOR LAKE AND U�D NG INSPECTIONS
INSPECTION
RECORD
SITE ADDRESS L N/VA7Eie, FAST
TYPE OF WORK Q g/ta. Ny
USE OF BUILDING
PERMIT NO. /G, dD • ' DATE ISSUED /Z . 31, 16-
BUILDER
SBUILDER ,5eelitip 62I. PHONE # 4/2.. 6%34, 4447?
INSPECTOR DATE
1.410*
I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
0100
FINAL I I. 2 y. /G
FOR ALL INSPECTIONS (952) 447-9850