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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
I. White File
2. Pink City
3 . Yellow Applicant
IO"-?-C;-o~
I PERMIT NO"(})_1l/3 (J-l
/.18;;;23
LEGAL DESCRIPTION (office use only)
ADDITION !I/fti:f
ZONING (office use)
;;)
~dc
LOT
BLOCK
""',
OWNER
(N ame)
[) 0 A.J "-.. Ie IUsc::-JL/
(Phone)
y LjIJ- _A)70 h
(Address)
BUILDER
(Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK
ORe-Siding
o New Construction
~wer Level Finish
o Misc.
ODeck
OPorch
ORe-Roofing
o Fireplace
OAlteration
OUtiIity Connection
OAddition
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
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 u on the property to perform needed inspections.
~.
x
Permit Valuation 3000.00
Permit Fee $ .7S'
Plan Check Fee $
State Surcharge $ S'O
Penalty $
Plumbing Permit Fee $ "Od
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
~~p
Building Official
I tJ~'j /~ z.."
/ .
Date
Contractor's License No.
10 - ).~;\~2-
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; 1"; $
Pressure Reducer $
City SAC and WAC # $
Water Tower Fee # $
Builder's Deposit $
Other E/eL.,Per/11 if $ 1.00
TOTAL DUE $ I J 17,;J~
Paid
Date
//~~d;{lj-d-I ~;ceiPtNO~/
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
Residential Bupding Permit Checklist
Basement Finish or Interior Alteration to Single Fa.mily Homes
BY:~~
Date: (0 -, d '1'" C',:J..
Building Permit #
Site Address
Pill:
~3d-3 f~~~{vood Sf-
Subdivision: fr ~ t/,:L,6.;J
Legal: L B
~9
EIisting StTucture:@or NO
Y'"E S
NO
I CONFORl'lIS TO ZONING
ORDINA1'{CE
'fES NO
Is this an expansion of ::he exisnng footprint or Refer to Planning
building height? ,fa
Is the property located within the flood plain? Refer to Plan.TJing I N~
Does tb.e alteration include any additional kitchens? I Refer to Planning I ,00
Does the proposed alteration include any outside Refer to Planning rJO
entrances other than patio doors?
Is the proposed use of the finished space or Refer to Plannmg
alte:-ation for anything ou,1.er than a nonnal single 0tJ
family home (office, groun horne, day C:lre, etc.)?
Tms CHECKLiST MUST BE COMPLETED ..\u'fD INCLUDED IN THE BUILDING PERJ.v!1T Fll.E TO
l'r'LlJNTAli'I A RECORD OF THE REVIEW.
L\'E:YC?L\ TC~.l."':' :C:-::CC.lJOC
PRIOR LAKE
INSPECTION RECORD
SITEADDRESS <19;<3- P~d
NATURE OF WORK L L-
USE OF BUILDING c~ ~
PERMIT NO. O~...... /lls d- DATE ISSUED /0- OLCj-GcA
CONTRACTOR DON _TElUse-fJ PHONE t/l/7 6-?Ot,
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTOR
DATE
I.... I
I_Prior to Backfill) I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING
INSULATION
, ELECTRICAL
. PLUMBING
"HEATING (if required)
1/-l3"~
I-} ~ ..-()l,
-01-
-01...-
,
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
~--~- ~
BUILDING
ELECTRICAL
PLUMBING
HEATING
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