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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
E- 3-0 J
(Please
ADDRESS
/7:Jt..l Oc,c.y,f, e/j Dn'(/( .5E
LEGAL DESCRIPTION (office use only) {'
1 I b~c, r;{ 1/
LOT BLOCK ADDITION
;J...d
Date Rec' d
~i~i~e ~:~y I PERMIT NO. 01- 0 A~I ~ I
Yellow Applicant ~ _:...J .
ZONING (office use)
I
PID
s- 31;1- ()C1j-
OWNER
(Name)
(Phone)
(Address)
(Address) 315 -
f:>k, )tl
(Phone)
~5/- ..25&- 7/~7
'/../ SS/;1;;;
TYPE OF WORK
o New Construction
ODeck
ORe-Siding
~Lower Level Finish
o Fireplace
o Misc.
OPorch
ORe-Roofing
OAddition
OAlteration
OUtility Connection
PROJECT COST /V ALUE (excluding land) $ IJ? YY{P
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 p~oper;y t~ ,,:erfo~ nefded ~n~ections.
X ~~4a i~'l:.~r
Signature
;;?ooO-S ~S-7
.5~ /-b' /
Date
Contractor's License No,
I?@rmit Fee VoL,... "- $ 3'/lOO.~
Piau CheLA. Fee F-eJL ~ 74. 7~
State Surcharge $ I.)()
Penalty $
Plumbing Permit Fee $ 40 .00
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
es Your Building Permit When Approved
5-8< Gz,l
Date
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I" . $
,
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
Pt4)C' 0 $ //&. 2S
TOTAL DUE S-'f!J-O I
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
White - Building
Canary - Engineering
Pink - Planning
The ('enter of the L.kC' Country
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
b /~ }for+oJLJ
~-- 3-0 /
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
IIJ~b;).. 1J eo--r::,'e JJ Dr S E
Accepted X
Accepted With Corrections
Denied ~ IJ /J. sz. _
Reviewed BY:V~ f/..dy~ Date: $"'-S-?P"z)
Comments:
~MAJ~ ~~.G~J~ ~~
- -
"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 172 c.o"2 T).e~t r,~.J.cl Or-
NATURE OF WORK L. L. J::.v..:-r~
USE OF BUILDING S FA
PERMIT NO. 61t4-e DATE ISSUED ~-A' @(
CONTRACTOR -D, L.. :10 )-~
NOTE: THIS IS NO'- A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
~ I
~ I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
INSPECTOR
DATE
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING if required~
ST
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
~ I I
FINALS
BUILDING
ELECTRICAL
PLUMBING
HEATING
DO NO. 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.
'.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (612) 447-9850