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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
-. . TEMPORARY CERTIFICATE OF ZONING-COMPLIANCE * 20../
tv 1 AND UTILITY CONNECTION PERMIT
4IX,vgSOlt' 1.white F!e J PERMIT la
A 1 `(, . � I
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
5a13 O cr eN& Lona. SE, Prior- La14., /YIN
I LEGAL DESCRIPTION(office.use.only).
` ' r
} LOT� BLOCK. ADDIT `N PIO
•
OWNER �A
(Name) r'k 1tr Gelri (,t3 (Phone) '•'IS7—S93N
(Address) S 1
a 3 Our c+'e fid. Laine. Er Prl - L,at�te r . MN
BUILDER
(Company Name) e 1 Rt i =1n,C,• MO W"/ (Phone) 7, ", 29- 9t7V S
�.c
(Contact Name) m�'^tahr (Phone) (0/2* 919'0118 61
(AtlMres). 3933 tv ) A/3rci Stret-l' Say I MA) I SS37B
TYPE OF WORK Q New Construction geek ❑Forch ORe-Roofing ORe-Siding [Lower Levet Finish 0 Fireplace
❑Addition DAlteration DUtility-Connection
CODE,j R.C. DLB.C. [aMisc.
Type o coon: I II III IV V AB PROJECT-OST/VALUE $ 6 5, OECI'4'6
Occupancy Gr A B E F 11 .1 M R S U
(excluding land)
Division: 1 2 3 4 5
I hereby certify that I have thmished information on this application which is to the best of my knowledge hue 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 c. revoke this pet mit far;ust cause. Furthermore,I hereby agree that the'city official or a designee may enter upon the property to perform needed ins ectit
x A. ILi :. • BC #.9/esq /6
Siwr, Contractor's License No. Date
Permit Valuation (00'C'0 _ s Park Support Fee # $
Permit Fee $ 1 3L,a l: SAC • # S
Plan Check Fee $ 8 - j 3 Water Meter Size-5/8"; 1"; $
State Surcharge $ '3 — 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 16 $ ZZ I
Thi , , 'on i ecoms Your Building Permit Wh Appr ed Paid�,/+�/ ` Receipt No. O I
3 I
By
Date
4- Zei l 6 9 iz. 1 S 3--
Building Oricia Date
This is t crtify that the regacia in the above application and urompanyinp uments- in accordance with the City Zoning Ordinance and may proceed as requested. This document
when r by 'City Planner constitutes a temporary Certificate of Z ' compo e and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued.i t
a�#lit._ t /-o IG
,, r .r Date Special Conditions,if any
24 hour-notice-for all inspections(952)447-9850
4646 Dakota Street Prior Lake,MN 55372
DEPART
ENT OF
PRIOR LAKE AND UILD NG INSP CITIO SING
INSPECTION
RECORD
SITE ADDRESS 52/3 DEElepEtD MA/6
TYPE OF WORK DEEKAar*
USE OF BUILDING
PERMIT NO. M. 339 DATE ISSUED . ZI. I� Q
BUILDER T�,/L, � /P.
Ue/~foVEL�/� PHONE # �ISZ. not 67416
INSPECTOR DATE
I FOOTING I �- I '5)t)16 I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
IMMO
I 5' 14 + I b
FOR ALL INSPECTIONS (952) 447-9850