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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
Lj-d-C;-O~
1. White File I PERMIT NO I
2. Pink City . /) ,_ ~) LI J /.
3 Yellow Applicant . Va. C./ ~C()
ZONING (office use)
p SD
LEGAL DESCRIPTION (office use only)
LOT
=; ~~/~"\) -f }{fcel~
OWNER
(Name)
(Address)
BUILDER
(Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK
o New Construction
ODeck
o Porch
DLower Level Finish
o Fireplace
OAddition
ORe-Roofing
)!1Alteration
ORe-Siding
o Misc. I!t:.f Cite 11)
vndL
PROJECT COST IV ALUE (excluding land) $
DUtility Connection
) ') /}
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 a t for the above-mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with
s. I fm aware that the building official can revoke this permit for just cause. Furthermore, I hereby agree that the C.ity official or a designee may
e pr . 0 rform needed inspections.
. '\ LiI.~0W2,
gnature Contractor's License No. Date
x
#
#
Permit Valuation Park Support Fee
Permit Fee $ SAC
Plan Check Fee $ l Water Meter Size 5/8"; I";
State Surcharge $ b-.OO 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 $
#
#
S--I- CG
I ~~~.~ *~-'~
Rec~o.
By~
o
l-uO
05. Of"
'fIr/ria
Date
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
~~,. ""' ili, C;~ ".""~'o""W<". ,-,., c~m~;/~/~~'" "'~5:: '":;;;":l:;rc~ """~
Date f'.4,~e:afConditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
Th(' ('('n.('r of th(' Lllkt ('oun.!")
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT c9- reCi-Va. lUy!)
(J
APPLICATION RECEIVED L(-,J..c] -oJ-....
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/'I3J-!) SA~ &(!~;U ~W
Accepted X--
Accepted With Corrections
Denied ~/J) _ I
Reviewed By: ~~
Comments:
Date: S-I-o~
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
The Cenler of 'he Like Counlry
White - Building
. Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT llCv\.;fO
APPLICATION RECEIVED LJ - 2 ( - ~ )
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
J4310 S~ ~ ,-)-
Accepted V Accepted With Corrections
Date:
l~/( t&2-
..
t.Lo tv.C*~ 'I'^-- I)\M,~&AJ~
&u:~ ~
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
Bt-JILDING AND INSPECTION
SITE ADDRESS -1:I3J.o S~ ~("\~ Tl:-
NATURE OF WORK k-'\-L~ t-.e.'^'o~
USE OF BUILDING 5F\J
PERMIT NO. 0 Z -04-2-& DATE ISSUED 5-(- fkx/2
CONTRACTOR VftN~ 0 PHONE 70'2- ::2.53-/9G,~
NOTE: THIS IS NOT A PER IT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
r--
I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
INSPECTOR
DATE
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
r=:::==- --
BUILDING
ELECTRICAL
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 h~ve 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