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Oi PR1o� CITY OF PRIOR LAKE BUILDING PERMIT, ate Recd t.
,� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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AI'A,NESO I. White File PERMIT NO .
3 Pink City - (DI C
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
° ? ®Ca 1 1 6 4 P
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
O �/- /
(Name) Af 1 / . 1),xe (Phone)
(Address) /Me/
BUILDER �!/ o // ' f •
(Company Name) fwd ( Phone) 7 ee u I
(Contact Name) � / �f r / 7 (Phone)
( Address) l9Yo // ' '>� �/!2- G!✓t'...-- Ma- /44--- TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ['Re-Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
Addition ❑Alteration ['Utility Connection A , //-
CODE: (]i.R.C. ❑LB.C. ❑ Misc. // �� � /G �r� �/"
Type of Construction: I II III IV V AB PROJECT COST /VALUE $ 1/4 1(149 - v
Occupancy Group: A B E F HI MR S U
(excluding land)
Division: 1 2 3 4 5
I hereby certify that I have furnished informatio, on this application which is to the best of my knowledge true and correct. I also certify that 1 am the owner or authorized agent for the
above - mentioned prope and that all constr Lion 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 revoke •:. permit f• cause urth more, I ree that the city official r�esi� y enter upon the property to perform needed inspections.
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Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ �A .- SAC # $
Plan Check Fee $ ( 0,2:3 Water Meter Size 5/8 "; 1 "; $
State Surcharge $ 40 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 $ `I'I .. 7;
.� ! 412_v /(
This Ap 404/ tion : ec es Y t ur Building Permit When ppro � d Paid ¢1 1r� Re pt No. grill/
�-- Date : „
■ a . 1 d z
�
Building of , Da /
This is to certify that the requc in the ab ve application and accompanying documents i n acco - ance with the City Zoning Ordinance and may proceed as requested. This document
when signed by, City% an r fnstu •s a temporary Certificate of Zoning complian and a )ws construction to commence. Before occupancy, a Certificate of Occupancy must be
issued. s
s
,/ (0 //
Planning Direr; . x ate Special Conditions, if any
ion otice for all inspections (952) 447 -9850, fax (952) 447 - 4245
4646 Dakota Street Prior Lake, MN 55372
PRIOR LAKE BUILD IN A DOF
INSPECTION
INSPECTION
RECORD /�
SITE ADDRESS bolo c,J wo
� s s
ioa� •
TYPE OF WORK r J�C.4e-
USE OF BUILDING tz6-c. A� /(L
PERMIT NO. (L - (((( DATE ISSUED ' 42O7(
BUILDER � -cA.� n�� PHONE # 152 - 367'b 2 1`/
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
•
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
14.0911. 1— otAi4ir IP' /0/z7 1 I
/
PLACE NO ONC � TE UNTIL ABOVE HAS BEEN SIGNED 1 (FRAMING /)(ke �� /f 1
FINAL 1 6 I iIke
FOR ALL INSPECTIONS (952) 447 -9850
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