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CPRj-/�/ \ eCITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE / tI`1 AND UTILITY CONNECTION PERMIT l� 3 ,�o.�
2 Willie
y PERMIT NO.
3 Yellow Applicant ,�r,..../��
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
3-3?40 6/6'665 5r (()
LEGAL DESCRIPTION(office use only) 1
LOT 3 BLOCK M ADDITION //l/ L C c(en PID,?j'- /3, - GC'3 -C
OWNER
(Name) L� i'A L / 4y#lt iT (Phone) Gni 2- C;(0 I- 3 3c-17
(Address) 3 3`67 (<,/Z,r G G,5 _I; a,o/o L.4Kill AI 53-3 7 2-
BUILDER r /1
(Company Name) D eek-lvc�n�5 r e_si 3,u 1 L.UA1�;, .1-AC- (Phone) !o I- 3 45-/'1V4-,
(Contact Name) Jc:sl:r` Scl,.' /i.t (Phone) ii-i tic
(Address) 2-7 1 3s C�ja.{5 rw —tk. Dr T.--3.4,,,r-r: 04"4„ -.5-ST-=''
TYPE OF WORK 0 New Construction , eck []Porch ORe-Roofing ORe-Siding DLower Level Finish 0 Fireplace
[]Addition [Alteration [Utility Connection
CODE: .R.C. DLB.C• 0 Misc:
Type of 'on: I II III IV V A B ?'S �
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $
Division: 1 2 3 4 5 (excluding 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 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
ofici revoke this pert it for just cause. Furthermore,I hereby agree that the city official or a designee mayenter the
upon property to pc.fo.»,needed inspections.
64-i/ 6//31/4y
Signature Contractor's License No. Date
Permit Valuation ,L/, Park Support Fee # $
Permit Fee $ Er,2-5— SAC # $
Plan Check Fee $ 6-7 •Z, Water Meter Size 5/8"; 1"; $
State Surcharge $ ((( r)- 74.) 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 $ Mt 7 4 /
1
CA-ILE-n ( . (, iv
a
This A. ,,'. : Y
.mes our Building Permit ' .•• Ap• ,red Paid `'44"J-/f l/ R 'pt No. /!r 7' 6)
,` Date 'L t.,, / - y
A i1n�► �. .
:wilding Official Date i
This is to certify that the req in..e above application and accompanying docum.o,is in. cordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by ity ..,er•.nstitutep temporary Certificate of Zoning comp .,ce. d allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued.
ilk— 4,114&_ 6) /6 /4
'an ring Di . . t'•to Special Conditions,if any
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS 6R/ S
NATURE OF WORK
USE OF BUILDING
PERMIT NO. �I 3 , DATE ISSUED 'WI" L'
CONTRACTOR 3 06---S/1 /2./2 PHONE( /,,'� 3a, / W' '
INSTALL EROSION CONRTOL ANIS MAINTAIN CLEAN STREETS AT ALL TIMES
INSPECTOR DATE
FOOTING -7 ( 21
(Prior To Backfill) t
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
=SIPICar
PIMIPMMOR
COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED
MIME, LATH
FINALS
11111.1111p,( PRIOR TO SODDING)
BUILDING ' } -- l ! 2- I I Lj
13.1=1201L
DO NOT OCCUPY UNTIL ABOVE HAS BEEN SIGNED
NOTICE
This card must be posted near an electrical service cabinet prior to rough-in inspections and
maintained until all inspections have been approved. On buildings and additions where no
service cabinet is available, card shall be placed near main entrance.
FOR ALL INSPECTIONS (952) 447-9850