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of PR / 0 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE &- 1 /i
7 AND UTILITY CONNECTION PERMIT
~iHNesol' I White File PERMIT NO . /
2 Pink City / 7 530
3 Yellow Applicant G•✓ /
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
1 1 1 1 W /A kiCtt i Qd pftkur L-6k-
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID 2'_ 2.91. O5/ 0
OWNER r�
(Name) �"' (Phone)
(Address) 14 (U) c W IN t-tu k, 1 y e r,",,, _,, p
BUILDER / r,
(Company Name) " hQ G CovtSf ywe f- 1 G h Z-1 6 -- (Phone) 61 z 232 / Z ci
(Contact Name) JAvN e b-- (Phone) hl2 Z 32 727-/
(Address) t 1 5 fict I s tCSG 1 L?t/t S /' Ix
TYPE OF WORK ❑ New Construction Deck ❑Porch DRe-Roofing DRe-Siding ['Lower Level Finish ❑ Fireplace
['Addition ❑Alterattion DUtility Connection
CODE: .R.C. ❑I.B.C. ❑ Misc.
Type of onstruction: I II III IV V AB PROJECT COST /VALUE $
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 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-mentronel property a that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. 1 am aware that the building
official can rev' as pert i for Just c Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed msp do s.
X �t � �i:� !/ /i f!9 fr
Signature Contractor's License No. to
Permit Valuation Park Support Fee # $
Permit Fee $ t `,.1 -15 SAC # $
Plan Check Fee $ 1C0- c't Water Meter Size 5/8 "; 1 "; $
State Surcharge $ . so 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
UNTO L1i : . 172 $ q 11
This ' plic on BecQm Your Building Permit en oved "+ (( /
p g ppr Pa id �L�� -Q ei.t No. �� /��
4 ! Date (., // d,
A A i �i I z —
r::u` RI Da e
1
This is to certify that he request in the above application and accompanying do Ime s is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when sig t th f " ity Rip er constitutes a temporary Certificate of Zoom om lance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued
- - 124 Date Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372
•
PRIOR LAKE BUILDING AND �NSPECTION
INSPECTION
RECORD
SITE ADDRESS /44/5 NNE 771a- glDyiE
TYPE OF WORK DEG
USE OF BUILDING /WS fr/K►
PERMIT NO. / DATE ISSUED G. Om.
BUILDER PHONE #
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
I FOOTING - 1 INSPECTOR 71 (y I
PLACE NS CONCRETE UNTIL ABOVE HAS BEE S GNED
FINAL I 1//_/7i
FOR ALL INSPECTIONS (952) 447 -9850