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i
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
~-- Z /-02-
1'1
'7 'i?{v~ to/,rei
It-.
1. White File
2 Pink City
3_ Yellow Applicant
PERMIT NO.~ 2. - 0':)7 3
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT ~ BLOCK S- ADDITION K\N)~l{~ It
PID 2 5 - 3t6 - 0490
OWNER ---
(Name) I t'^^~~ CP.erri....~
C"" r
(Address) ~
(Phone)
9 52--- ~ 03 - u 11/0
BUILDER
(Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK
o New Construction
~ck
o Porch
ORe-Roofing
ORe-Siding
o Lower Level Finish
o Fireplace
PROJECT COST IV ALUE (excluding land) $
OAddition
o Alteration
OUtility Connection
o Misc.
x
I hereby certify that I
authorized agent for
submitted plans.
enter ul2. e pro
ave ished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or
e above- entioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with
aware that e building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
to perform eeded inspections.
Signature
Permit Valuation '5,000.1>0
Permit Fee $ 8~.2..C:;-
Plan Check Fee $ ~(I . , (
State Surcharge $ 1 . "'-(")
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
mes Your Building Permit When Approved
~~2L'-o-L
Date
Contractor's License No.
<C . -:> -:>.- l' ..,.
..L-l-~' ~ L-
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 "b1H~"~ 5- 22,..-0 2- $ 13..8, ~&
I Rece~ No, l/;-- f 3 >
By , ':1~
Paid
Date ~/-g 107-
. I
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 ail inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake. MN 55372
~
PRIOR LAKE
INSPECTION
RECORD
SITE ADDRESS / 4579 t>t. U6L3/ /20 /leA / t.- N6
TYPE OF WORK 0 EClc
USE OF BUILDING /205 r9 /IC-
,
PERMIT NO. (}Z-0573 DATE ISSUED 5-Zz-02-
BUILDER P~6L PHONE # 4tJ.3. (J14-()
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
INSP~ ' DATE
I FOOTING I I '~J!;ot/
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I FRAMING I I
I FINAL I vlf)/ I ~/}-1/r.0
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (952) 447-9850
~-
ThE' ('f'nfer of Ihe Ll1kt' Countn;
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
P6;e,e/~~ TiM
,
5- 2/- 02-
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/~571 L3L-U6!3//2.L) .77eA/L- Nb
::<
Accepted
Accepted With Corrections
Denied ;;;Z ~
Reviewed By: ~ .
Date:
5'- 2 2 --a<=-
Comments:
/Z6rtV 7716 O~ f(;t:1AJO <J U'I
"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."