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of PR / 0 � CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
0 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE /9 7 //
AND UTILITY CONNECTION PERMIT
m
4t'NNESOlR I. White File • PERMIT NO /// ���/// 0
3 Pink City J / ! / 1
3 Yellow City Applicant / ` F!
(Please type or print and sign at bottom)
ADDRESS _ ZONING (office use)
d c:5 7 Ca 5 JA fftr CCM -1/./ O , 2 07 k -
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (P hone)
7.0 -yy
(Address) 3 5 .(-(.e. / � 1447/ Pr-id/ k f el it) 53
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ► heck ❑Porch DRe-Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
['Addition ❑Altera on ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
of Construction: 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 1
1 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 - mentioned pro. i and that all const uction 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 revo t 'is p. - mit for dust caul urtherm , I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
Signature Contractor's License No. • Date
Permit Valuation 5-Oa Park Support Fee # $
Permit Fee $ 1..5. - SAC # $
Plan Check Fee $ (0 2� Water Meter Size 5/8 "; 1 "; $
State Surcharge $ t � 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 $ 41.15-
This App ion Be o r es our Building Permit When Appro ed Paid Rec t No. &I
Date /O. BY
` /.. Il•�'= ( 0 �� 1
• uilding Of icia /''.-D Date
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 temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director 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 DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS 37(05 J , 2S fi
TYPE OF WORK _S7? /2.S
USE OF BUILDING /r' ,'
PERMIT NO. / / . /6 Co / DATE ISSUED /O. 7_ / /
BUILDER 73E/24 i€ ON PHONE # G <2. 7 2. 4--
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR •'1 DAT
I FOOTING -� 1 ' 4 /611/
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
- 1 1
I FINAL 1 1 )
FOR ALL INSPECTIONS (952) 447 - 9850
•