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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd A, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ' x AND UTILITY CONNECTION PERMIT ' l° 13 U x '�I•NNE$OlD 1 white City PERMIT NO./3 Yellow Applicant (Please type or print and sign at bottom) ADDRESS s t // C 1 (; �/Jf� / ZONING office use) 6, �([ Ore / � ;J -t- r PvI�Y(i'J& • 4/ " 5 7? LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER - (Name) ° J CS. v P el \A l (Phone) tol,,l - 7D.2 -2 2-ce- eftrZi S (Address) ( LC sox, hzG�—) n iii. id' n vt tft,-z._ 1S2 - 2/b -- 7 44(Mi- BUILDER (Company Name) (Phone) (Contact Name) (Phone) (Address) TYPE OF WORK 0 New Construction J�Deck OPorch ❑Re- Roofing URe- Siding ❑Lower Level Finish ❑ Fireplace ❑Addition DAlte iron ['Utility Connection CODE.R.C. DI.B.C. D Misc Type of Construction: I II III P1 V A B Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $ Division: 1 2 3 4 5 (excluding land) i 1 hereby certify that I have fumrshe. information on this application which is to the best of my knowledge true and correct 1 also certify that I am the owner 01 authorized agent for the above- mennone. -prod rty an th. , all co .n non . 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 re +keh ,,,p, u for fist cau urthermore, 1 hereby agree that the city official or a designee may enter upon the property to pertorm needed Inspections K .1/ 10"...a2412 WSI8 I iv' Si;, atu.` i Contractor's License No. Date Permit Valuation 060 ' Park Support Fee # $ Permit Fee $ g - SAC # $ Plan Check Fee $ S 3 6 Water Meter Size 5/8 ", I "; $ State Surcharge $ Pressure Reducer $ l_� --a 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 $ (4 ( ( This App t ati Be e • t t ur Building Permit Whe Ap , oved Paid 14=7 1 1 eipt No. (f(4 1 I Date C . (• 13 " 1? / P M _ B utldme Official — fate This is to ce ; that t e re.0 t n the above Application and accompanying d ume s is in accordance with the City Zoning Ordinance and may proceed as requested This document when signe..y t. • , ' P n e constitutes a temporary Certificate of Zonal,' comp ante and allows consnucuon to commence Before occupancy, a Cetntcate 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 4 PRIOR LAKE BUILDING A D�INSPECTION INSPECTION RECORD SITE ADDRESS G79/ Mea,ur�" s TYPE OF WORK DEZ4- USE OF BUILDING ger/t 6,•/.3 PERMIT NO. 13 • SS� DAT ISSU (Of 6, BUILDER K/1�A�P PHONE # G /Z. 70L• 2L40 NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUMENT INSPECTOR DATE I FOOTING 1 l� 1 k. PLACE NO CONCRETE UNTIL ABOVE HA BEEN SIGNED paw" 1 1 FINAL 1 1 5 )Z- FOR ALL INSPECTIONS (952) 447 -9850