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o� YK I0 •P CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
ti � _ : sy
C TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �, �3
AND UTILITY CONNECTION PERMIT
1. White File
2. Pink City PERMIT NO. /3 _ 3 01
3. Yellow Applicant
(Please type or print and sign at bottom) ZONING (office use)
ADDRESS
33 l 6-p. s -s St-(,/
LEGAL DESCRIPTION (office use only)
' G� PID . Q` Z , U z_3.
LOT BLOCK 3 ADDITION Alf, /' ��
((Name) c� 11 f vui 1 C ke_vvvyi l (Phone) c t g ^ Vs ' ! 3J _
(Address) ,"?,.(2. l 6-r ' y y ,.. ` S
BUILDER (Phone)
(Company Name)
(Contact Name) (Phone)
(Address) I C
TYPE OF WORK ❑ New Construction %Deck Porch ❑Re- Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
['Addition ❑Alteration ['Utility Connection . f
CODE: .R.C. I.B.C. ❑ mi.: /2 < p`� `�
Type of Construction: I II III IV V A B COST /VALUE $
Occupancy Group: A B E F III MR S U PROJECT
Division: 1 2 3 4 5 (excluding CO land)
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 ownergrauthorized agent for the
above - mentioned prope and that a construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
offici revo th psi 't for just j use. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X Date
Si? tore Contractor's License No.
Permit Valuationepz --42 -4,0 ,- Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ 1 ppp4 3 Water Meter Size 5/8 "; 1 "; $
/ Pressure Reducer $
State Surcharge $ 7
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 ,) 5— ,, l0 . $ (7t. q 5
This , . plicatio i Becom Your Building Permit Whe App ved Paid " INAIMIIIII Recei.t No. ff
Date By 5
A . 719"
F_
/3 I I ' 1 3 eke d
Building Official _ Dat
This is to i that th requ in the above application and accompanying do ents ' ' accordance with the City Zoning Ordinance and may proceed as requested. This document
when si: ;d by e i P1. er constitutes a temporary Certificate of Zoning ,mpli. e and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued /
G '--- b
Planning Dire � .- Date Special Conditions, if any
24T�►our notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS 332-1
TYPE OF WORK S 2 '
USE OF BUILDING t`3e7/
PERMIT NO. /3 : 0,202_ DATE ISSUED --5 3 - l 3
BUILDER S' ° ' r -' PHONE # . 9-�
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
l X > %t o INSPECTOR ? < DATE
FOOTING m, 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
1
FINAL � / �/ �? I
FOR ALL INSPECTIONS (952) 447 -9850