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oF ptt� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
.. � AND UTILITY CONNECTION PERMIT �' � � � �
U �r
'1rjNNES�•�!' I. White File
z � ; �� � PERMIT NO. !y Z
3 Yellow Applican�
Please e or rint and si at bottom)
ADDRESS ZOIVING (ott'ice use)
� � � � ��'��� � � �'� J . �•
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
�aWNER yl ri ` � � � � 1 I ( e � (Phone) v `� -� � ���j
� 1 \.
(Address) � � � � � v
Bi.TILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
� ��SS 4�IN00
CODE: .C. ❑I.B.C. l� Misc. _�
Type of on ction: I II III N V A B ��
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE S
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have fumished information on this application which is to the best uf my knuwledge true and correct. 1 also certify that I am the owner or authonzed agent for the
above-mentioned prope�ty and that all construction will conform ro all existing state and local laws and will proceed in accordance with submitted plans. I am awam that the buildmg
ufficial can r oke this permit for just caus errtore, I hereby agree that the c�ry official or a designee may enrer upon the property ro perform necded mspections.
X
Signature Contractor's License No. Date
Permit Valuation ,� Park Support Fee # $
�
Permit Fee $ Z � � SAC # $
Plan Check Fee $ ����;� Water Meter Size 5/8"; 1"; $
State Surcharge $ s—� 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 $ TOT.4L DUE $ ',
This A icatio Be e Yow Building Pernut When p ved Paid S Rec t NO. ,)
Date _ ¢ /"2— B
`�' � / `Z
Buildina Ut icia Date
Th�s is to e ify that t re ucst in the above plicahon and accompanying docume s is i accordance with the Ciry Zoning Ordinance and may protteA as requcsted. This d�KUment
when � d by t t P nn consututes a temporary Certificate of Zoning com �ance nd alluws construction ro commence. Befure occupancy, a Ceruticate uf Occupancy must be
issuc
, ¢ 1 �
D te Special Conditions, if any
24, ur noticc for ali inspections (9S2) 447-9850, fxx (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS I �������" �u�
TYPE OF WORK . �-��-�--
USE OF BUILDING �
PERMIT NO. f Z--°��-�- DATE ISSUED f Z
BUILDER _��t sr��° f'�I�.��-- PHONE # �'� -�d�.���'
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
FRAMING
FINAL
FOR ALL iNSPECTtONS (952) 447-9850
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� CITY OF P IflR LA#�E �
.. . BUlLQING R 7 P�.AN REViEW o�e detectors sha11 be located
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This drawing is neithera legally 2corded map nora sur�ey and is not �2jp �Ca�@ �f
intended to be used as one. This dra;ving is a compilation of records, '� ineh = 44 feet
inform2tion, and data locafed in various city, county, and state o�ces, and
other sources affec[ing the area shown, and is to he used for re`erence W E -�+'-
purposzs only. Scott County is not responsible for any inaccuracies herein
contained. I� discrepancies are found, please contact th2 Scott Counry Map Date � �}���
Surveyors o�ice. 4�3�2� � 2 S
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