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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
''1/ 3{)-()~
White File I PERMIT NO ~
Pink City . ()? -() AI -
Yellow Applicant _ V ~V _
ADDRESS
ZONING (office use)
/<1173
I3lu~b
/R
LEGAL DESCRIPTION (office use only)
BLOCK b ADDITIO
OWNER
(N ame)
~~/
/ /7t
,;2//d
PIn>>-- 339- OqS-
LOT
(Phone)
q<;; 2. 2.?{- ';C$-'
(Address)
/lIC-
BUILDER
(N ame)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK
o New Construction
~eck
OPorch
ORe-Roofing
ORe-Siding
OLower Level Finish
o Fireplace
OAddition
OAlteration
OUtility Connection
o Misc.
PROJECT COST /V ALUE (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 1_ a~ aware tha e bud offiCial can revoke thiS permit for Just cause Furthermore, I hereby agree that the city offiCial or a designee may
enter upon property_to erD neede nspectlOns d
X ---- jf}.-;/cL.
Signature Contractor's License No. Dafe
Permit Fee $
fun~ITkFcr $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ /38 . elP
~ ~(~!o~;ceiPtNOit-?'71
Permit Valuation
om Boo<ling P,=it When Appro"" I
c(- 30 -(Y/ -
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
when signed by the City Planner constitutes a temporary Certiticate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
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
Planning Director
White - Building
Canary - Engineering
Pink - Planning
The ('fnler nr the l..kt Counl.,.,
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT S'e--cll /l ~Ir-SO~
APPLICATION RECEIVED 4 - 2>0 - C:::.~
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
I Lit 7 <;? 13 IIAt: hi >d T;~ /LIe
~
Accepted Accepted With Corrections
Denied :-3 ~
Reviewed B~ -~
~ts~ J~ ~ aJ
Date:
t/.- ~O -02-
"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
SITE ADDRESS HI V8 ~ lue.bo-& Tt=..
TYPE OF WORK DC2C(,
USE OF BUILDING ~ F \~
PERMIT NO. ~2 ~O 4t;z.- DATE ISSUED o-f-O?c.
BUILDER J]vJ.~ COJV1. PHONE # q5;?- 2S3'--~~~
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
'~. DATE
I FOOTING I. I 5/(/{}V
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I~ I I
Call between 8:00 and 9:00 A.M. for all in
FOR ALL INSPECTIONS (952) 447-9850
FINAL