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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
PERMIT NOoqB ....393
(Please type or print and sin at bottom)
ADDRESS
M~sh~
ZONING (office use)
teet '
l11 O~)
LEGAL DESCRIPTION (office use only)
PID 2<)-4z.\ -Q)7.,<?
LOT
BLOCK
ADDITION
&:R SO'n VI ~
(Address) \ I [ () S
~ +h~ t:::- \ II (\3
MUSVt.~ ~
G 1J--116~0<1Lf
~5-:z, l J-
(Phone)
Y(IOY Lct~1 MN
BUILDER iJ
(Company Name) \ I (lYY\ -f ,~UX f~) \ \'\ C.
(Contact Name) t\/\II' 1.p ,II ~
(Address) qq 01 \\. S ~ ~ Pr. S-.v - J-ip 6
(phone) (UJ j -L\ \ d-- - ~)-CfJ ~
(phone) S~
.~ PI "'1 MdV~1 (VlrJ 'S'S Y l{ 1
TYPE OF WORK 0 New Construction ODeck OPorch iRe-ROOfing ORe-Siding OLower Level Finish 0 Fireplace
DAddition DAlteration DUtility Connection
CODE: OI.R.C. OI.B.C.
Type of Construction:
Occupancy Group: A B
Division:
o Misc:
I
E
II
F
1
ill IV V A
HIM R
2 3 4 5
'$;'StXJ . ~
B
S U
PROJECTCOST/VALUE $
(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
o;cial can remn~e that the ci~ official or ad3{)~U;~~~rty to perform neededC~77; /0 9
Signature Contractor's License No. f Date (
I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
I Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fire;1-ce Permit fee
I Z~oO.
1$ 74- (-<)
I $
I $ (~ ?-.c:;
I $
1$
I $
1$
IS...
I Park Support Fee
I SAC
Water Meter Size 5/8"; I";
Pressure Reducer
#
#
$
$
I $
1$
1$
1$
j$
1$
1$
Sewer/Water Connection Fee
Water Tower Fee
I Builder's Deposit
I Other
I TOTAL DUE
#
#
(0. ~
'~;)
{l,p- ,
~J/ I fo / nrc
, I
Paid
Date
. ReceiPtNo~b 04_-S
By I
I
"-- /
This is to certify that the request ~pplication and accompanying documents is in accordance with the Ci~ Zoning Ordinance and may proceed as requested. This document
when signed by the Ci~ 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
24 hour notice for aU inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
Special Conditions, if any
DATE TIME
CITY OF PRIOR LAKE G. b 7-Cl-6'
INSPECTION NOTICE SCHEDULED
ADDRESS f7 (tY; yo/l~.~
OWNER CONTR.
PHONE NO. PERMIT NO. ~-~~
-
o FOOTING o PLUMBING RI o EX/GRAD/FILLING
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE RI
o INSULATION o SEWER HOOKUP o FIREPLACE FINAL
o FINAL o PLUMBING FINAL o GAS LINE AIR TST
o SITE INSPECTION o MECH FIN;( 0
COMMENTS: (?J7J
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~ORKSATISFACTORY. PROC
o CORRECT ACTION AND P~ED
o CORRECT f~K...6~R REINSPECTION BEFORE COVERING
Inspector: r /I I Owner/Contr:
( ,
.CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl