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oF PRI�� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,, ,,�,,' , TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
�' � ' �' ' AND UTILITY CONNECTION PERMIT
� � � �� 6�
M��'NES��P I. White File
2. Pink �,� PERMIT NO. �_. Q
3 Yellow Applicant
Please e or rint and si at bottom)
ZONING (office use)
� � �i o �, s ��� ��,�, ,, � k �.� � �3 �a �2� so
LEGAL DESCRIPTION (office use only)
LOT � BLOCK � ADDITION �/,��,,.7 PID 2S' ZcJ l• O� ,
o�R w�h/, ls • 6� - y6 -a3�
v 8 v � fi a r✓ ' •v
(Address)
�
BUII.,DER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF W�RK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fire,place �� )
❑Addition �1Alteration ❑Utility Connection �p� I
CODE: �.R.C. ❑I.B.C. � Misc. � �
Type of C�onstruction: I II III IV V A B pROJECT COST/VALUE $� 0 U, U O
Occupancy Group: A B E H I M R S U
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have fiimished information on this application which is to the best of my knowledge we and correct. I also certify that I am the owner or authoriud agent for the
above-mentioned properry and that all construction will conform to all existing state and local laws and wi11 proceed in accordance with submitted plans. I am aware that the building
official can revoke t permi c ermore, I hereby a ree t �ty o�cial or a designee may enter upon the property to perform necded inspections.
X �w�,�� `�,� �-a���
Contractor's License No.
ermit Valuation s�p� d,� Park Support Fee # $
Permit Fee $ ?L�� 7� SAC # $
Plan Check Fee $ �.. Water Meter Size 5/8"; 1"; $
State Surcharge $�� ys Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee�, $ Q D � Builder's Deposit $
i
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DLTE $�(� � a 0
This Application Becomes Your Building Perntit When Approved Paid � Z " Recei t No. 'Z
► Date B
O�'
Buildim� Ofticial ate
Thu is to certify that the reqnest in the above application and accompanying documena is in accordance with the Ciry Zoning Ordinance and may proceed u requested. This ducument
when signed by the City Planner consututes a temporary Ce�ti6cate of Zoning compliance and allows construction ro commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour noticc for all inspections (9S2) 447-9850, fax (952) 447-4245
4646 Dakota Sueet Prior Lake, MN 55372
; DEPARTMENT OF .
`�, ' � � BUILDING AND INSPECTION
SiTE ADDRESS � � � l /'�i�0 � .�1'�� /J� � .
TYPE O� WORK C�llS' «��i�!&S �.�{�. E�k�►�'T M�'�I T�7G .t hlE,�OI� -�kJ
USE OF BUILDING ./�. a . ;�d�t
PERMIT NC�. _Q $ r���7 DATE 1SSUED O�'
BUfLDER �'�ZE&Q�,,4� ! ��''1 �1J�3'Gt� PHONE #_7�,�''�y
NOTE: THlS IS NOT A PERMIT �OR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEP����RATE DOCUMENT -
_ �_. >: : . INSPECTOq DATE
�S �. � � � � ,
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
FRAMING Gt IV i T �
FiNAI.
FOR ALL INSPECTIONS (952) 447-9850
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