HomeMy WebLinkAboutBuilding Permit 10. 0191 g§ 2
k ....5 ce U. c w E
II . \ \ \ I �
g a�a� >
/ , o■��� 0 2
tu §� E0��0 . § z
| 0000015C
0000 1 > &
S R
ce x
o 0
0 k.) d §§ § § \
2 §§ I -J 0 0 o k
a ii 1- § 2_? ?27 § c W ;
0 S 0 �fw��� a z 2 (
ow o
04
}�§ }� § @ § j
oeocOO j } 0 % re W
`8 c g a
W . 0 § 0 2 %
�� § §R 0 /� -� \
re § § z o ® › ~ t- a
g z o 0- Z < w R ■ %
a g co z z cl z W ® w W .. _ w
U. re b z ooE 2 }§ 2 k k/ 0 §
% 0 § zzz § 0 0 0 &
Q?
0 o a COOe0O 0 C O O /
o PRi� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
A TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 3 3 ( d
''' AND UTILITY CONNECTION PERMIT
M, NNesoo• I. white File PERMIT NO
3 Yell P /
Pink City / 0
3 ow Applicant ( , l V
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
IS 3 y 1 + w; I a Tt/ It)/ C r+
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER n
(Name) ¶ C-&°o r Q r G Ct tP (Phone) 6 \ d - 2-31 -10 9-1
(Address)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction Deck ❑Porch ['Re-Roofing ❑Re- Siding ❑Lower Level Finish 1=1 Fireplace
['Addition ❑Altera on ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc. A 17.P f A -rt.a 0"-k--p 'G
Type of Construction: I II III IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COST /VALUE $ L700
Division: 1 2 3 4 5 (excluding land)
1
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 - mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official car . evoke this permit for ju ause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x � .. - 2.9 - /
Signature Contractor's License No. Date
Permit Valuation a v .. Park Support Fee # $
Permit Fee $ '73 l' SAC # $
Plan Check Fee $ 4.1 14 Water Meter Size 5/8 "; 1 "; $
State Surcharge $ t Pressure Reducer $
I 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 $ ( Z Z_ G 1
Thi pp ' tion Becomes Your Building Permit en A roved Paid ( Receipt No. S �� '
i et t
1j Date 3.j r Q By �"
I 3 30 /o
Building lc , Date
this is to c rtify that a request in tit above application and accompanying doc ments i in accordance with the City Zoning Ordinance and may proceed as requested. This document
then sig." by t i ty Planner constitutes a temporary Certificate of Zoning c mplian and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
sued.
A iii4. to O
'lannin_ D' - . ate 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 I �� tc-o
TYPE OF WORK
USE OF BUILDING tz` A In
PERMIT NO. rya (q/ DATE ISSUED
BUILDER - 1 - 7 7 --v.= , 6"- . - W 'i' PHONE # 0
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
FOOTING hO C I -5 /
PLACE NO CONCRETE UNTIL ABOVE HA BEEN SIGNED
fsopmens 1 1
FINAL J 14 ((- ( 3
FOR ALL INSPECTIONS (952) 447 -9850