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(Please
ADDRESS
31,)'6
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
n at bottom)
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Date Rec' d
/2-, (1,00
1 White
Pink
Yellow
I PERMIT NO.
File
City
Applicant
0. /10/
ZONING (office lIse)
LOT
BLOCK
LEGAL DESCRIPTION (office use only)
ADDITION
PID
OWNER
(Name)
(Phone)
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
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(Phone) ("5'{- Yh?- t.(8 ~
(Phone) ~S- (~ 7>S-- '-I;Jct 'f
MW
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing ORe-Siding ~ower Level fimsh 0 fireplace
DAdditlOn DAlteration o Utility ConnectIon
CODE: DI.R.c. DI.B.c.
Type of Constmction:
Occupancy Group: A B
Division:
I
E
II
F
I
o Mise.
III
H
2
IV V
I M
3 4
A
R
5
B
S
PROJECT COST IV ALUE
(excluding land)
$
U
I hereby certify that I have furnIshed mformatlOn on this application which is to the best of my knowledge true and ('orrect. I also certify that I am the owner or authOrized agent t~n the
Jhnvl'- honed proper and that all CllI1strllctHlI1 will conform to all existmg state and local laws and will proceed in accordance with submItted plans I am aware that the buildIng
(ltlicia e tl).' mlt for Just cause Furthermore, I hereby agree that the City official or a deSignee may enter upon the propelty to perform needed IIlspectlOI1S
x
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
I Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Signature
$
$
$
-J 600.00
/ .7S-
_~oJ3 ;)..<:.J(.J
Contractor's License No.
/2- I Y-06_
Date
.~o
0.00
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; 1"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
,
Water Tower Fee # $
Builder's Deposit I $
Other $
TOTAL DUE $ 1/(;.2...5-
Paid
Date
52-
//~. 2S
I~, 0 ,
ThiS IS to certify that the request in the abllVI' application and accompanYll1g documents is In accordance with the City Zoning Ordinance Jnd may proceed as requested ThiS document
when signed by the eny Planner cunstItutes a temporary Certificate of ZOning compliance and allmvs c(lOstructinn to commence Before llccllpancy, a Certificate UfOccllpancy must he
Isslled
Planning Director
Special Conditions, if any
Date
24 honr notice for all inspections (952) 447-9850. fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS 375 F fVj/lJt:]rl ~
NATURE OF WORK ~~~c~ ~V~L-
USE OF BUILDING /U7 ff/?--
PERMIT NO. &. //0 I DATE ISSUED /?-.- /'7,0 (,
CONTRACTOR F/I;-V-1/;J077JJJ PHONE u5/. 4&3. 4--825
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
..
I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
INSPECTOR
DATE
------------- - ~-
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING if required)
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
BUILDING
ELECTRICAL
PLUMBING
HEATING
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