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of "44 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
0�. > TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 3. 7• /6
AND UTILITY CONNECTION PERMIT
y'Iv1rESer I.white F1
2. Pink City /
PERMIT NO. / ,
3 Yellow A licam
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
1130 0 A 5ex irk ikv(t,
•
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER e
(Name) ( \' 6e\c (Phone) r /
(Address) 1 C Ac. ec A A
BUILDER
(Company Name) R (ii"V'i.' `t`: ii 4. Pitrotr./ ,41%„,,,...i-14" (Phone) ‘15-1—` 1 Gt 2--'jk-76:,
(Contact Name) I v'e l/ 7 51'tf4 Y"kl Lk., (Phone)
(Address) ft2 % f /! 6� 41 2 (2-Tv 'St" 1-‘,..1-‘,.. y+. (z-evA( Y s ( 1
TYPE OF WORK 0 New Construction Z115eck ❑Porch ❑Re-Roofing ORe-Siding OLower Level Finish 0 Fireplace
°Addition ❑Alteration ❑Utility Connection
f.
CODE: 11 ' . ❑LB.C, 0 Misc.
Type of onstruction: I II III IV V A B
Occupancy Group: ABE F RI MR SU PROJECT COST/VALUE $ °00
(excluding land)
Division: 1 2 3 4 5
I hereby certify that , fumi • • '•formation 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-mentione• 'rope . • that all onstruction 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 mit for}us e. Funo . ore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
NISigna re - Contractor's License No. Date
Permit Valuation 11 a a a. o 0 Park Support Fee # $
Permit Fee $ /q (. 2-.5 SAC # $
Plan Check Fee $ 95 7 / Water Meter Size 5/8"; 1"; $
State Surcharge $ 3_6-6 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 aqua, _Tv_ I-67 $ 2..4"co, 4--6,
This Ap •cation '• omes, our Building Permit Wh Ap ved Paid L th,elf," R eipt No. it�7U
/ .. 3 �� Date 3 1,4 t
tuii 'g Official dote %
This is to certify t t the r•quest.in the above application and accompanying docu•ents' n accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by e Ci 'annex constitutes a reniporary Certificate of Zoning c plia '•and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued.
/4 6
Date Special Conditions,if any _
24 hour notice for all inspections(952)447-9850
A4.44 rs.,t...t., ct a u.:,,,.I.t.o Adht S4111
PRIOR LAKE DEPARTMENT OF ENGINEERING
AND BUILDING INSPECTIONS
INSPECTION
RECORD
SITE ADDRESS / 4" 3 U(o As-/2eA/ ,i-✓ -.
TYPE OF WORK D6G4-
USE OF BUILDING /2Z. s /1/12.-
PERMIT NO. /lo. /6-9' DATE ISSUED 3. 7. I ep
BUILDER //a/ COA/5772. PR-oPE2iy /`/ /'?T PHONE # 292-. 3876
Nrk°4 � INSPECTOR DATE
FOOTING x3 , I 1 10 I
PLACE NO CONCRETEI
UNTIL ABOVE HAS BEEN SIGNED
I alfseloSitI I
I
FINAL `i 1 b
I
FOR ALL INSPECTIONS (952) 447-9850