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CITY OF PRIOR LAKE
BUILDING PERMIT,
! .PORARY CERTIFICATE OF
ZONING COMPLIANCE
ILlTY CONNECTION PERMIT
DIRECTIONS .
SPACES NUMBERED 1 TWA" 1 r M__ I gC r-ILLI::ll .111
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRESS
11S
Q
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
00.010'1;
1. DATE
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
l'
(Jfll. No.)
Gt \"2.... \. \~ ... ~'1--1
8}:lI.IRJa4 . '\
(Address)
(Name)
s
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
Re-roofing 0 Porch 0
Re-s' ing 0 Finish Basement 0
SEATS
16. PROJECT COSTNALUE
I hereby certify that I have fumished 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 ention d prop rty and at 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 i c revo this e it for' cause. F ermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
?.,. .? - crt )
License No. '7' --
New Construction 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
Depth
17. COMPLETION DATE
No
SETBACKS: Required
Actual
FOR ADMINISTRATIVE USE
Front
Back
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
I ;(0/90 or C96J
.
SURVEY
PLOT PLAN
o COPIES
o
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4 QU. 2~ /
Permit Fee ................................... $ ...:2 J ~~
City:
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ..... ................. ................. $
.c;o
.J
AI1AoJ1. y()
./fV(~.1
Plumbing Permit Fee ....................... $
Certificate of Occupancy
Issued
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Pressure Reducer .......................... $
Meter Horn.............................. on.. $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
Paid ~ Receipt No.
Date
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 ested. 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.
City Planner
Date
24 hour notice for all inspections (952) 447-9850
Special Conditions ff any
.
P R I 0 R LA KE DEPARTMENT OF
, BUILDING AND INSPECTION
INSPECTION RECORD
4('15 Q.A~ 18-
F'N'<'H ()N.~ ~ \,J L~~
t2e-s p. {2- I I
DATE ISSUED ~/ at ~o
, ,
CONTRACTOR ~~Nfst <;;'(1.- 1,8- -{S"2.; .
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
SITE ADDRESS
NATURE OF WORK
USE OF BUILDING
PERMIT NO.
00 . 070B
...-,- I
I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
INSPECTOR
DATE
FRAMING
INSULATION
ELECTRICAL
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.
.
.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (612) 447-9850