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Date Rec' d
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White File
2 Pink City
3. Yellow Applicant
LEGAL DESCRIPTION (office use only)
LOT ~ BLOCK ~ ADDITION ~,\~.v~~ '~.r-c\ S
PID L'So - ~ \ <C. a'\. \ - t>
OWNER
(Name)
~o~~~ ~~r
I
(Phone)
\ C\ S""L l 'i '-\ (). '5-1. 't) 'S
(Address)
~(,...--~..
BUILDER
(Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK
o New Construction
OLower Level Finish
o Fireplace
PROJECT COST IV ALUE (excluding land) $
OAddition
OAlteration
OUtility Connection
o Misc.
ORe-Roofing
ORe-Siding
eck
OPorch
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 property to perform needed inspections.
~O _II Krc-.--lc.
Signature
x
~-~-to:..i
Date
Contractor's License No.
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
rg-jf-e!
Date
Park Support Fee # $
SAC # $
Water Meter Size5/8"; 1"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ IIS'''U
I Paid
Date
\ Receipt No. L.J-7~jo
By tf
gJ~ ~
~ 31' (
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
Residential Building Permit Checklist
Deck Additions to Single Family Homes
By:(2/S
Date: 8 -71. 'Za:> I
Building Permit #
Site AddressS/ 'i 7
Legal: L G?
Pill:
L-ex '~ b
B..?
Zoning:
Subdivision: LJj\~ p~
Existing Structure: YES or NO
I CONFORMS TO ZONING
ORDINANCE
NO
I
YES
I
Yard Setbacks: NOT APPLICABLE Requirement Proposed
MEETS CODE
. Side Yard 10'
~5' if abutting a street, 30' if abutting a street in '20 '
Cardinal Ridge)
. Side Yard 10' l../O\
. Rear Yard 25' 40'
. Townhouses Must be consistent with
approved plan for
development
ANY PROPOSED DECK NOT MEETING THE ABOVE CRITERIA MUST BE REFERRED TO THE
PLANNING DEPARTMENT. ALSO, ANY DECK ON A LOT WITH A SUSPECTED BLUFF, OR ANY
OTHER UNUSUAL CIRCUMSTANCE MUST BE REFERRED TO THE PLANNING DEPARTMENT.
TIns CHECKLIST MUST BE COMPLETED AND INCLUDED IN THE BUILDING PERMIT FILE TO
MAINTAIN A RECORD OF THE REVIEW.
L:\TEMPLATE\DECKCHCK.DOC
PRIOR LAKE DEPARTMENT OF
;' " BUILDING AND INSPECTION
INSPECTION
RECORD
fJN1 Lep/t;j1o#\/ c-t-
De.[ Ie '
SITE ADDRESS
TYPE OF WORK
USE OF BUILDING 5 ~
PERMIT NO. $~ DATE ISSUED p;' 3/~QI
BUILDER cJ . . se~ PHONE # llqO~53()S
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
~OR ~TE
I FOOTING I. rqr;g!IJ/
~RETE UNTIL ABO~ HAS BEEli'SIGNED
_ - I _ lq/~?~,
I FINAL
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS \952) 447-9850
I
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