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CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS I 71 3l../
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o ~SULA TION
"......crFINAL
o SITE INSPECTION
COMMENTS:
DATE
SCHEDULED -8/ OJ I / '" TIME
rP ~t
t.u.~ ~
CONTR.
PERMIT NO.
0.3 .l r4-..3
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
n 11\
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rJA
t~
o WORK SATISFACTORY, PROCEED
o CORRECT AC~I AND PROCEED
o CORRE~ ' CALL FOR REINSPECTION BEFORE COVERING
Inspector: r; Owner/Contr:
CALt.: ~50 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNOTl
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and sign at bottom)
ADDRESS
1. White File
2 Pink City
3_ Yellow Applicant
Date Rec' d
PERMIT NO.V 3.-.. / / '-/ j
ZONING (officcuse)
//)l0Lj- ~~o~?7f /fJ-U~loL-v [,.;t..J
LEGAL DESCRIPTION (office use only)
LOT
ADDITION X
BLOCK
OWNER
(Name)
C 4'/(//
~ CltM ,.j-J-
(Address)
BUILDER
(Name)
(Contact Name)
(Address)
TYPE OF WORK
o New Construction
o Misc.
P Ii ]);(J fjr;tVniSh
PROJECT COST IV ALUE (excluding land) $
PIDdY 34/1-01-7-0
(Phone) 9'.5;1- ~ '/J-IzI/t s-
(Phone)
(Phone)
ODeck
o Porch
ORe-Roofing
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
~ter;?~7jd#ons. y;,~?~P3
Signature Contractor's License No. Date
Permit Valuation Q5C16.--
Permit Fee $ }Q-7Y
Plan Check Fee $ 1,,:3-~
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
~ ~ ?/e?7103
Building Official I Date
o Fireplace
OAddition
o Alteration
# $
# $
$
$
# $
# $
$
$
$
//0.
t/53</c:J:::l
I
Park Support Fee
SAC
Water Meter Size 5/8"; 1";
Pressure Reducer
City SAC and WAC
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
,,:'7X.. ,- ---
Paid /.W,
Date <]' - ;;;- -1- 0 .5
Receipt No.
By Y
cJ
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 DEPARTMENT OF
. BUILDING AND INSPECTION
INSPECTION
SITEADDRESS -n~~ ORD~ ~
TYPE OF WORK ~M- L.t- ~~
USE OF BUILDING ~ CS. J::A . .
PERMIT NO. () 3-/'" J DATE ISSUED 8/~7/O'
BUILDER PHONE #
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
~ FRAMING I I . i
(' V~ rl~ ~ )'uy~
J FINAL j
f. I
&-r~~ F~
FOR ALL INSPECTIONS (952) 447-9850