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CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
B TEMPORARY CERTIFICATE OF ZONING COMPLIANCE a /
AND UTILITY CONNECTION PERMIT
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I.White File 6
z. Pink city PERMIT NO. /5 �f1/j y.
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESSgg ZONING(office use)
V? i /74
47 ( /
LEGAL DESCRIPTION(office use only) /,� /
LOT7 BLOCK / ADDITION `[.'/"1J `rer/� /,#h PID Z5.34,2 . 0 Q Q„ 0
OWNER '554 h� cam/
(Name) Q // (Phone)
(Address) ljj e
BUILDER /A'
(Company Name) //7" �✓t..!_ & (Phone) ?'6-0.2-02/.2 ” 55,.--C'
(Contact Name) OA"
(Phone) 6/.4 ' .,23.2 ` 22/3
A /
(Address) 51(257 C/1 fC,"b of--Z/ ,r, /f///7 f/ //3f /1/? 5:5'73/
TYPE OF WORK ❑New Construction ArDeck ['Porch ❑Re-Roofing ❑Re-Siding ['Lower Level Finish ❑Fireplace
DAddition ['Alteration ['Utility Connection
CODE: 1.R.C. ❑I.B.C. D Misc:
Type of Construction: I II IIIIV V AB
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ v Cl
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 pro.erty 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 it's.-. it r jusci.se. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x % /' , ,6eGJ�'//5_ -v2v2 / S
Signature Contractor's License No. Date
Permit Valuation sve'0- . Park Support Fee # $
Permit Fee $ 1 -i,- SAC # $
Plan Check Fee $ 4-1 r el+ Water Meter Size 5/8";1"; $
State Surcharge $ ( — ,, 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
This All* do.Be'�rimes Your Builtling Permit n Appr ed Paid /Z2..(' _ pt No. / �'S5
1 i ��y ���. Date 1 z- (S-� j
7F�
c _
Building Offi, a ate
This is to ce i •at the equest in the above application and accompanying do ments is accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed b ..erer coorary Certificate of Zonifillim ang mpliance nd allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued. c
ic,
'•'Planning Director �� Special Conditions,if any
24 hour notice for 1 inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
PRIORLAKEDEPARTMENT, G NS ECITIONSNG
INSPECTION
RECORD
SITE ADDRESS +¢�Qqp��/ ��yCL��
TYPE OF WORK It. ��1��• �'ai�
USE OF BUILDING 4:11 /�
PERMIT NO. DA ISSUED (, Z2,, /s
BUILDER Aarg/d_ mier_. PHONE # 9,$3, Z/Z� 3sliv
INSPECTOR DATE
FOOTING r ' NEmib-
PLACE NO CONCRETE UNTIL : OVE HAS BEEN SIGNED
MIK:===:=:j3
FINAL 11111112Mall
FOR ALL INSPECTIONS (952) 447-9850