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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
Cj-/IJ ~ 01-
1. White
2 Pink
] Yellow
File
City
Applicant
\ PERMIT NO. 02 -/118
ZONING (office use)
.el
ADDRESS
Lf(pd.~
Ov t-v' 100 k:
DV.'\le..
S E,
LEGAL DESCRIPTION (office use only)
LOTJ BLOCK 7 ADDITION WOO 0 fC'4066
?--tJ D
PID?S - z.9~ - a8-0
l.J(Q~~
~Je.uW\CtV\V\
OUlvlwt
(Phone)
OWNE~
(Name) e. a,^
(Address)
.
V-I~
~i==
fhDV k
BUILDER
(Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK
o New Construction
~Lower Level Finish
0# e; p7)rl
ODeck
OPorch
ORe-Roofing
ORe-Siding
Wireplace
OAddition
o Alteration
OUtility Connection
o Misc.
PROJECT COST IV 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 property and that all construction will conform to all existing state and local laws and will proceed in accordance with
sub ed 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
exn r upo e pr~erty to p~ n~e~_ed inspections.
.... . I ~ 9- /0 --~OO~
Signature Contractor's License No. Date
Permit Valuation i 000.00
Permit Fee $ 3~7~
Plan Check Fee $ -
State Surcharge $ .50
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 $
City SAC and WAC # $
Water Tower Fee # $
Builder's Deposit $
Other EL-&t!-I jUMrl- $ I. e (J
TOTAL DUE ~ '1- l 0 ""0 z.....- $ 'If/.Z5'
""107 (J
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 1-1/2-3 Ot/EK!-t.-oO,e::.. O,e/v6 5&
NATURE OF WORK L- OW&/G t..-6V6 L-
USE OF BUILDING J8t5J 11/~
PERMIT NO. () Z - / / /6 . DATE ISSUED q--(O- () 2-
CONTRACTOR jt/6UP1/1}J A/., OC5ft AJ PHONE -1-~7 - 754S'
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
\
i- -...
I
I
_ J_ ill) I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
.
C
-
FRAMING
INSULATION
ELECTRICAL
111/(./
YlI(J
( () j L- <1r- ())-
to -/-'1- OL
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
.vvp
Y1IJ0
V1((/
10 - Lt' /02.-
(o-J-~-OL
10 - 2--'6 - 02-
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
-- - - -
L _ ----
BUILDING
ELECTRICAL
/s -Cf}
HEATING -d7
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