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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
- ~ rO'~
Hf')o --J'd-
I PERMIT NO. ;}J-/~/?I
White File
Pink City
Yellow Applicant
LEGAL DESCRIPTION (office use only)
LOT
ADDITION
I2LS .# ~9
#/
BLOCK
Ma.v ~
S-z,O\) ~
(Address)
(Phone)
=:~)ER ~Y\~f- V
(~ame) J44Db
(L~gS) IS II \
rA5Y\~~L1L6VV
~ \..L \.1-1<... \,-t II ( fllt-\.V \..-1
~ U-.vvt SV111 1"
I
'~) Dt~L -440 '-1/~1)
(jIIIae )
H~ SS.6b~
TYPE OF WORK
o New Construction
OLower Level Finish
o Misc.
OPorch
ORe-Roofing
ireplace
OAddition
OAlteration
PROJECT COST IV ALUE (excluding land) $
ZONING (office use)
r< I Sf)
PID
Df~2-- 441-l A'il
ORe-Siding
OUtility 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
'"'" "p'n the property to perl"nn~. nee d inspections.
X ~. . __~ z..()LH.~H{J lu141~ z-.
Sliiature ....lik._'~License No. ~
Permit Valuation 3000. <90
Permit Fee $ ~~ .2.-5
Plan Check Fee $ 5~. II
State Surcharge $ /.50
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
~~
Building Official
loft~a L--
I Date
Park Support Fee
SAC
#
#
$
$
$
$
$
$
$
$
TOTAL DUE
! \ 10 . J2R-()[)--
:..J 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
Water Meter Size 5/8"; I";
Pressure Reducer
City SAC and WAC
Water Tower Fee
Builder's Deposit
Other
#
#
I Paid
Date
--d 38,8to
L<1 t, f b - ~VeceiPt No b'~q ';,)-
/ /6. d-Lf'YJ By ~-.,
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.
White - Building
Canary - Engineering
Pink - Planning
Th(' Crnlt'r or .h(' Lab COunll")'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT ~~ ~ .
APPLICATION RECEIVED / /)-cJd- -(T CJ -/
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at: ~
5()(){) F~ P~tL $/U
Accepted
Accepted With Corrections
~
Denied
Reviewed By:
~
~
'f~p
&L
Date: /<:1/')'-3~ 2--
,
Comments:
~~ -cn.d-,
"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 \~CJO 7'JeoS'T /fy/,v(€ f?//ze.-f-F
TYPE OF WORK Hb~ '-~<!-
USE OF BUILDING ..)',h{) ,
PERMIT NO. tJ 2 --/~/ 9 DATE ISSUED /tJ/~31o;;J
,
BUILDER ~tJ(It::~ fd,..)s-T!2uC77o,J PHONE # 95~ -9Yd - 77r;;;(j
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FOOTING I ~ I !/-I-OA
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I I
I FINAL
I ~ I ~.;rr_Oc.f
Call between 8:00 and 9:00 A.M. 10- :11 inspections
FOR ALL INSPECTIONS (952) 447-9850
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