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of PR/0 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE •
AND UTILITY CONNECTION PERMIT 7 /Z/-�
$/d'AtEgoi�
I. Whim Fite
3 pink Ciel PERMIT NO. /3 .5-/
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS
56g/
kurofri / ZONING i(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER ,✓1.
(Name) L(C Itr.� 6e5 (Phone)
(Address) /3' 'U ilcith 46-z 4,st_ Arlyr L4.t-4.—_
BUILDER /
(Company Name) i°0-0 (..,r-.744 wt o i(.)7 (Phone) l7/ 2P--
(Contact Name) G/Tc,(( i /9r,/ (Phone)
(Phone)
/
(Address) [d If ,?4— be t_ 4-40 f✓r;',/- Lc.f-c._.
TYPE OF WORK 0 New Construction G adck ❑Porch ❑Re-Roofin /
❑Addition ❑Atte d ❑Utility Connection
o S ❑Re-Siding ❑Lower Level Fini h 0Fireplace
CODE: DI.R.C. DI.B.C. 0 Misc. /
Type of Construction: I II III IV V A B
Occupancy Group: ABE F HI MR SU PROJECT C,¢�ST/VALUE $
Division: 1 2 3 4 5 (exclu nn�land)
I hereby certify that I :ve 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-mention•, .ra.'rty and that all construction will conform to all existing state and focal laws �qand will proceed in accordance with submitted plans. I am aware that the building
official can re•. e,4 permit for Just cause. Furthermore,I hereby agree that the city official or a desi nee may enter upon the property to perform needed inspections.
X CD3 1'‘ 7-1(-- /3
Signature Contractor's License No. Date
Permit Valuation 3 coo 4 0 U Park Support Fee # $
Permit Fee $ l 0 0 , SAC # $
Plan Check Fee $ 5-7 r 3 Water Meter Size 5/8"; 1"; $
State Surcharge $ J 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 MAtii) 143 q,s-Di $ 4_7 , I /
This App ti r Becomes`our Building Permit en A oved /� [1
Paid � 'r eipt No. 6 9���
_ r Date 7. 12 0
iltI'
$r
Bu'ding Ofticia Date /
This is to ce that t - equest in the above application and accompanying docum, is is in cordance with the City Zoning Ordinance and may proceed as requested. This document
when Signe• .y t C' 'tanner constitutes a temporary Certificate of Zoning corn, iance a .allows construction to commence. Before occupancy,a Certificate of Occuparcy must be
issued. '^--------...
A ' '- 7 rz-
r PI:—ing Director ".1 ----- Dat Special Conditions,if any
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372
DE
ARTMENT
F
PRIOR LAKE BUILDING A D�INSPECTION
INSPECTION
REC • RD
SITE ADDRESS T % v/ •
TYPE OF WORK P
USE OF BUILDING ��7
PERMIT NO. DAT ISSUED •
BUILDER � �' � PHONE # 1A,Pro
NOTE: THIS I NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
FOOTING � AO-
PLACE
NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
IFINAL I 2/PA-
FOR
]
FOR ALL INSPECTIONS (952) 447-9850