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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
~i~i~e ~::y I PERMIT NO. /) '_/' Ice I
Yellow Applicant , (L....~ -7....U '
ZONING (office use)
/4l~O(P
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/1/&
,el
LEGAL DESCRIPTION (office use only)
LOT (BLOCK Z. ADDITION
2IVp
PID
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OWNER
(Name)
---- ~..
J I/YJC I /-I!j
/
.~
Pl-l/} lJ
/
LIV
P/~/
(Phone) (Q57.") 44c -.c/17-,
BUILDER
(N ame)
(Contact Name)
(Address)
(Phone)
(Phone)
o Misc. AID
o New Construction
tke ~<<3;;m'~
DDeck
DPorch
ORe-Roofing
ORe-Siding
TYPE OF WORK
o Fireplace DAddition DAlteration
Lkv tE-t--
PROJECT COST IV ALUE (excluding land) $
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
enter upo~pe. ~ to perf~rm nee~ed insp~ons.
X )<"'~--''''C k~; 1-". IFV.~ L /1- ~ (-'_~
J .$gnature (7 Contractor's License No. Date
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
4000 . ~
$ ~l.zt;
$
$ Zoo
$
$ 40_ 00
$
$
$
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
City SAC and WAC # $
Water Tower Fee # $
Builder's Deposit $
Other ae;dJf!JeA'l- $ /. () 0
TOTAL DUE $ 13D.25"
r Building Permit When Approved
II ~!O~
Date
Paid
Date
'itf>'2ic-. I ReceiPt:;!lMtfb
tr 4 - c-T 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.
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
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File
2. Gold City
3 Yellow Applicant
I PERMITNOQ}_/t/s~1
I
ZONING (office use)
~
(Please
ADDRESS
'_-IL)~ 04?/Id:~l1-e
LA/
LOT
BLOCK
ADDITION
LEGAL DESCRIPTION (office use only)
I' ~~OTZ K 2HAJ
(Address) I ( no.. ~ L/1/. n/,e;-
.. , . ~q52~:40-yrn I
'Pr/() v L C{ /AL ) /VJ /v /- .e;- 3
APPLICANT
(Name)
(Phone)
(Address)
(Address)
(City)
(Zip Code)
(Contact Person)
A __AtlU'IfM[WiiRE ~;7? 2C,Y;(
(Phone)
CANT PLEAS COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (] or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $
Building Permit #
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Paid
lfo .-
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
.50
'-10..-
Date
By
Date
Building Official
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS
NATURE OF WORK
USE OF BUILDING
PERMIT NO. ~ - DATE ISSUED /1- Lj-Od----'
CONTRACTOFf0,m[i I tlL PHONE L./L/O-91//
NOTE: THIS IS NOT A ERMIT F R ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPA ATE DOCUMENT
OCV.N--elC;~ L-/J
I
INSPECTOR
DATE
1- I~"C I
,. L UnMrION (Prior to Backfill) I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING {l)"'~ V.b, J1f If<J)..d2-
HEATING (if required)
ACE
NE AIR TEST
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
It. )o-(/'l.
It- >0- (fL.
I L- ')ov(/l..
r (}~ ~l
Prior to Sodding)
BUILDING
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUPY UNTIL ABOVE HAS
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.
(p.- ~'()3
--S-U?
- <{" - (/3
BEEN SIGNED
FOR ALL INSPECTIONS (952) 447-9850