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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
g/ ~5 ( 0 7
I PERMIT NO. 0 7 - O.?/ Y I
I White
Pink
Yellow
File
City
Applicant
Hi h tt 11 d Ave, tJ,lJ,
fl'(C)J' LA.~
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name)
(Address)
H\
~.Nw
PID2.5.14-3. 000.0
(Phone)
p{; CJ r l.M~ rYI AJ
'15'2. -""'-17- t&11~
BUILDER
(Company Name) A.~,1: ebf'\~ltr,^,L('Oh (Phone) <:152- 292- 26QO
(Contact Name) frl Tho fV\o...5 (Phone)
(Address) "3402 ~~ C\f'cle We.n5Te.v' MN 550et;
TYPE OF WORK 0 New Construction ~Deck DPorch ~e-Roofing ~Re-Siding DLower Level Finish 0 Fireplace
DAddition DAlteration DUtility Connection
CODE: ~.R.C. DI.B.c.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
III
H
2
IV V
I M
3 4
o Mise
A
R
5
B
S
U
PROJECT COST IV ALUE $
(excluding land)
I fi I ., 00 <:>4>
I hereby certify that I have hlrmshed infOrmatIOn on this application which is to the best of my knowledge true and correct. I also certIfy that I am the owner Of authOrized agent for the
Jonvc-mcntlOncd property and that all construction Will conform to all eXIstmg state and lncallaws and will proceed in accordance with submitted plans. 1 am aware that the ouildmg
official can re ke tl s pel~ct Furthermore, I hereby agree that the CltyifiCial or a deSIgnee may enter upon the propeny to perform needed ~P:tli"& _ 0,
X .
Signature Contractor's License No. Date
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
This Application Becomes Your Building Permit When Approved
~
~
Pit 3/n 7
. DatJ
Buildlllg Unlctal
Park Support Fee
SAC
#
#
$
$
$
$
$
$
$
$
$
Planning Director
Water Meter Size 5/8"; 1",
Pressure Reducer
Sewer/Water Connection Fee
#
#
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
Till' I' to certify that the request m the above application and accompanymg documents IS m accordance WIth the CllY Zoning Ordmance and may pmceed as requested TIllS document
when signed by the CIty Planner constItutes a temporalY Certificate of Zonll1g comphance and allows constructIOn to commence. Before occupancy, a Certificate of Occupancy must be
ISsued
Date
24 hOllr notice for all inspections (952) ~~7-9850. fax (952) 447-~245
4646 Dakota Street Prior Lake, MN 55372
Special Conditions, if any
~
P RIO R LA K E g~::'~~~~~~TD ~~SPECTION
INSPECTION
RECORD
SITE ADDRESS IS~~ H/&~~N~ AM: Atw.
TYPE OF WORK_ 'e14J~~ ffe~~J
USE OF BUILDING ~ ,:; 0, = ~..y.
PERMIT NO.O?-08!!!x D~TE ISSUEDlJ'frt.Yfi '?
BUILDER AJJ. ~-m..,l) PHONE 1152 -Z'-2 -a;.,0
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
~CWR , ~AT'
I FOOTING I l:5 191.?o~ ]
, ..
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
.... I I I
I FINAL 11M../' I V{ -Lf</{I) I
FOR ALL INSPECTIONS (952) 447-9850