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White - Building
Canary - Engineering
Pink - Planning
The ('('nler of thE' L.kt Counlr)'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
r\
NAME OF APPLICANT ~ ~ r- ~'-- +0 Y f
APPLICATION RECEIVED /O~d-/ --0 ~
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
I~;? IL;~ (b~1cb1?chcL./
Accepted
Accepted With Corrections
v//
Denied
Reviewed By:
~~
~~ O-L( ~-~
Date:
/c'J/d. 3;{?-
~/ vk~
Comments:
"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
BUILDING AND INSPECTION
SITE ADDRESS I to / Lf cd-
NATURE OF WORK NEW
USE OF BUILDING s. ~D t
PERMIT NO. 02 -/4/6 DATE ISSUED ICJId-~ /01-
CONTRACTOR &z.i ~ ~ ~ "pti "'" h:i~". PHON E tQ'i; ( - 77 'i - 61 'j I
NOTE: THIS IS NOT A PE MIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
('A~ ~
f'~ t2.t:.-f+ C) JL) ~ 0 A T/O..J
INSPECTOR
DATE
FOOTING 10 - 3i '-VL,
FOUNDATION (Prior to Backfill) ) I ~ 'i .. 0 ~
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING
INSULATION
ELECTRICAL
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
BUILDING f) _
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUpy UNTIL ABOVE
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
J
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
/&1'12-
~oJJ/l/Vo/2ri
I
Date Rec' d
1 0 - 2-: I ~ d 2.......
1. White
2 Pink
3_ Yellow
File
City
Applicant
I PERMIT NO'OZ-/4/f
VI2- .
~ONING (office use)
puD
LEGAL DESCRIPTION (office use only)
LOT j BLOCK
/ ADDITION
MtuJI/I//-rv ,e/.o6b /.fr
PID ZS. zqq- 00/- 0
~~~R C--lf\1 v'\~c" l\l\r~
n",t
.
r,
Xl [v.,r\
(Address)
(Phone)
(1)' L' 2..2.(.: . L 2'll'
~ ';; ,,; j}'c "--~I (i I (",.." 1/11
BUILDER
(Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK
o New Construction
DDeck
ORe-Siding
OLower Level Finish
o Fireplace
PROJECT COST IV ALUE (excluding land) $
o Misc.
ORe-Roofing
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 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 the pro rty to perform needed-inspections.
\.l '
x
..
Permit Valuation -Tf fJ(!)OtfJ I tJ 0
Permit Fee $ /53.2-5
Plan Check Fee $ ~(p, &; I
State Surcharge $ '-I.Ot)
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $ '-If). () ()
This Application Becomes Your Building Permit When Approved
~. ~/-;
Building Official
/t1../;z:?h "2-
/ Date
DAddition
o Alteration
. ( "
I . . c.... IT._
Date
$
$
$
$
$
$
$
$
$
TOTAL DUE
Contractor's License No,
Park Support Fee
SAC
#
#
Water Meter Size 5/8"; 1";
Pressure Reducer
City SAC and WAC
Water Tower Fee
Builder's Deposit
Other
#
#
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
:;;;""" '" '~.e City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
~ .~ /~.3~L ~d( l-~j~
Planning Director , Date Special.eonditions, ifany
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 E~gle Creek Avenue Prior Lake, MN 55372
I Paid
Date