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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT tl,< iff "' () L
(Please
ADDRESS
I White
Pink
J Yellow
File
City
Applicant
PERMIT NO. ()~. /IZ {p
ZONING (office use)
~
~f- /JCU~"e ~.
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
'e-h vno KeAs
~~Ir:b(.~ - cJOd -- (J.J-O
OWNER
(Name)
I j
(}.r e y loll Ie ./t.....
...
!/'\-;
(Phone)
?srZ-L/Yl-.5-:l ?-7
(Address)
I BUILDER
I (Company Name)
l(contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofmg
~ddition OAlteration OUtility ConnectIon 0 Mise.
CODE: "I5<!i.R.C. DI.B.c.
Type of &struction: I II III IV V A B
Occupancy Group: A B E F HIM R S U
Division: I 2 3 4 5
ORe-Siding OLower Level Finish
o Fireplace
PROJECT COST/VALUE $
(excluding land)
I hereby certify that I have nlrnished mformation on this application which 15 to the best of my knowledge true and correct. I also certify that I am the owner or authonzed agent for the
above-mentIOned property and thai all construction will conform to all eXIstlOg state and local laws and will proceed in accordance with submitted plans I am aware that the buildmg
official can revoke this permit for Just cause Furthermore, I hereby agree that the City official or a designee may enter upon the propelty to perform needed mspectlons
x
Signature
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
This Application Becomes Your Building Pennit When Approved
~~JJ~
I 13uildmg Otlicial
/(J/rft(
{ Dde .
Contractor's License No.
9<-;)'?'- c' y
Date '
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE ~ 11 1.04- $ "3 Z o. 7:[1;;
Paid
Date
sz.o. ~
1/. Z.{} 4-
ThIS IS to certify that the request 10 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 temporaty Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
isslIed
~_~m. ~ pJII~
Planning Director '~ate
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
----
.c-:J1hTt~ - Buildaijg::::.
Canary - Engineering
Pink - Planning
Tht' C"t'ntt'f of Ihe Lake ('ounlO
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
o ~ 55 1<-0 V l c,H I V I ~
q. 26.04-
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
~Z4-0
ST. PAUl- AVt;3.
Accepted With Corrections
~
Accepted
Denied
~ fe;j)~
Date: / 94:~<I
Reviewed By:
Comments:
-~'1 1-0 ~ ~Cl~Jc:-
~_._~~
~-~~~
pj..A~ ~ ~~ f~
lott.
r ~~ ~ -"
"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."
White - Building
Canarv - Engineering
C-:Pink - Plan~
The ('..nter of Ihl! La".. Counlr~'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
f~
;: r-j
,,- , \
..--.,,,....
APPLICATION RECEIVED
I,
'-. - /"
i~~-
,
The Buildingl, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
" ,l
.:..~,- .t-. (
! l \ I L.-. ' \ ", t:: .
Accepted With Corrections L
Accepted
Denied
Reviewed ~~ rt\ .~
Comments:
Date:
(f l' /0'(
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sr=-~'. l-1 1)lUcL.L (~JS
,
o~ of S,,.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 DEPARTMENT OF
, BUILDING AND INSPECTION
INSPECTION RECORD
~~TE~~D~i~~Rf~&f~i~~'~ ~~
USE OF BUILDING Jr~D. ,
~~~~~~OR IIil4- .:i~"ICr;TE ISSUEDpc~r~ ff'2 -5JH
N,OTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
~OR DATE
I FOOTING I. I II / Iz/01
~IL ABOVE HAS B!E~ SIGNED
ROUGH - INS
FRAMING
INSULATION
ElEC
COVER NO WORK UNTil ABOVE HAS BEEN SIGNED
I I
FINALS
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