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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please
ADDRESS
at bottom)
Date Rec' d
7. (, Jp!-
White
Pink
Yellow
File
City
Applicant
I PERMIT NO. 04-. ou7r I
MN 5'531
ZONING (office use)
R./
LEGAL DESCRIPTION (office use only)
LOT 7 BLOCK 5 ADDITION W~oOIUDGJ!3
2 Nt)
PID2.S'. z94. 0+1.0
OWNER
(Name) Te..:~t
~v\e.. ~h: r
(Address)
(Phone) Q6d.- - ~/<::ll- 7u I 7
BUILDER
I (Company Name)
I (Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ~Deck OPorch ORe.Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition OAlteration OUtility Connection 0 Misc.
CODE: $.R.C. DI.B.c.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
F
I
III IV V A
HIM R
2 3 4 5
B
S U
PROJECT COST /V ALUE $
(excluding land)
x
I hereby certify that I have hlrmshed 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-mentlOned 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
off.cial can revoke this permH for Just cause Furthermore, I hereby agree that the City official or a deSignee may enter upon the property to perform needed InSpectlOns. .
h -:t:L-' ~-fo-lJl-\
Signature
Permit Valuation
Permit Fee
$
$
$
$
$
$
$
$
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
This Application Becomes Your Building Pennit When Approved
z~~
Building Ofticial
7/7/0'1
r 6ale
Contractor's License No,
Park Support Fee
SAC
#
#
Date
$
$
$
$
$
$
$
$
$
Planning Director
Date
24 hour notice for all inspections (952) 447-9850. fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
Special Conditions, if any
Water Meter Size 5/8"; I";
Pressure Reducer
Sewer/Water Connection Fee #
Water Tower Fee #
Builder's Deposit
Other
TOTALDUE ~ 1.1.o.f-
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 temporalY Certificate of ZonIng compliance and allows construction to commence Before occupancy, a Certificate of Occupancy must be
issued
~
PRIOR LAKE
INSPECTION
RECORD
SITE ADDRESS /73foh fIolU'ZON 7}eAIL
TYPE OF WORK '3ffijc..
USE OF BUILDING S /1/12-
PERMIT NO. 04. 0& 1q I DATE ISSUED 7. (P. 04- .
BUILDER Kt/6575Je.. PHONE # #.7. 70/7
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTOR DATE
I FOOTING I PlI],/ I -'1-1-'3- 0-,
. PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
G11.rJ1rta I I
J FINAL I I
FOR ALL INSPECTIONS (952) 447-9850
~