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Z.1 of PRtp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ; ;�� ��
AND UTILITY CONNECTION PERMIT L��
4'kNESOOP I. White File PERMIT NO.
2. Pink City /5- 956
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZG(office use)
Ai Come R(Amm;INc\�Uirck 7-r ; L Qt c),(1-civ P1t 55��c
LEGAL DESCRIPTION(office use only) 2 2
LOT BLOCK ADDITION PID 02c 1 339. el 6C 0
OWNER „ 5r
(Name) S ctV
CrCr� 4- X581 0.r r (Phone) (Q ,''K'
) IS— c):7 Gc1 Or
(q5a `7 l S-d-`7`1 O
(Address) L/6xs \-VkmTy‘;.taAV); rck 7rcx‘L Q c,(
, 1,- P 5S3-7a.—.) 5S3 .
BUILDER
(Company Name) F)0.- Yr�'- (Phone)
(Contact Name) _____,5_a.rf-R. (Phone)
(Address)
TYPE OF WORK ❑New Construction X.Deck ❑Porch ❑Re-Roofing ❑Re-Siding ['Lower Level Finish ❑Fireplace
DAddition ['Alteration ❑Utility Connection
CODE: W.O'.R.C. ❑I.B.C. ❑Misc.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have finnished 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 can revoke this permit for just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
Signature Contractor's License No. Date
Permit Valuation306O. 06 Park Support Fee # $
�
Permit Fee $ e 8 , 2.--C SAC # $
Plan Check Fee $ . 3 Co Water Meter Size 5/8"; 1"; $
1 J V
State Surcharge $ eT�v 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 $ ` e 7
5 .24ko
This `l t icati t Beco t - i • g Permit Wh: Appr,ved Paid J y 7. ? IP receipt No.
��i
A Q f �. Date €3.20-45-
- -/S By 1'YLi-e_X -
:. �� 1 1
Bui! 1'1— , —cial ')ate
This is to c hat h•request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when sign t e ll it Planner stitutes a t'Thporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued
lannin irector rlit. 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
•
ENT OF
PRIOR LAKE AND B ILIDING INSP C'TIONSNG
INSPECTION
RECORD
SITE ADDRESS 4(i25 R
TYPE OF WORK
USE OF BUILDING
PERMIT NO. DATE ISSUED
BUILDER Ong ON PHONE # 952., ?IS. x*1
INSPECTOR � ,DATE
( FOOTING 1)--)C- I '� I �,2�� I
PLACE
NO CONCRETE UNTIL ABOVE HAS BEE1� SIGN D
I FINAL I G�I 1i����
FOR ALL INSPECTIONS (952) 447-9850