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CITY OF PRIOR LAKE BUILDING PERMIT, ~ate Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ~'.
AND UTILITY CONNECTION PERMIT /'''' ;;1, h'~...,
t-l_/ L/'~
LEGAL DESCRIPTION (office use only)
LOT & BLOCK ') ADDITION
.- ; \
C'
~ ~\
OWNER
(Name)
~
f ,,(
~<.
(Address)
BUILDER ~
(Name)
(Contact Name)
(Address)
L <:)\1....., . ~\.-~
<:;-:J( ^ l ,,_ ~
TYPE OF WORK
o New Construction
~ower Level Finish
o Misc.
I. White File I PERMIT NO I
2. Pink City , 02--0 lOa..
3. Vellow Applicant V .
ZONING (office use)
(2.../
PID25-37S - 02--1- (>
(Phone) 5s:~:;> - rV (-. S~()y
(Phone) <1 S- r!;) -
(Phone)
~eck
o Fireplace
o Porch
DRe~Roofing
DAlt ation
DRe~Siding
DAddition
o Utility Connection
PROJECT COST IV ALUE (excluding land) $
Jj5',ooD
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 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 th~o perfo;!! n,ee ed inspections.
X L ----~ /0 7 & I - ::'.J j- O.;J
Signature Contractor's License No. Date
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $ 00
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
es Your Building Permit When Approved
/ - )0-02-
Date
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; 1 "; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ 2-0 z. . 4-b
Paid
Date
~~;;: it
I ~~. -1':!d7~
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director
Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS /5"3qll ~\~ HotV\ ~SS
NATURE OF WORK ~ ~. ""&s.eW\~CA~ ~"'i'3.~
USE OF BUILDING SFD
PERMIT NO. f7Z--o /00 DATE ISSUED I-so -o~
CONTRACTOR :0 (} I QctwshUC.t-I'OVl PHONE 9s~ - </l'ol- 518 Y"
,
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
~
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING t...' .
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 B EN 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.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (952) 447-9850