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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
If. '7 of;
I. White
2. Pink
3 Yellow
File
City
Applicant
,
959 ~
PERMIT NO'08.
at bottom)
Jd)DImSS
/725fp
1'1,q,es;-l FI e:LO
1-tV SE
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID2.$" 380,003.0
f<<!W r ~Z. Z S-lP. ~ 7 f2.s-
OWNER
~)
(Address)
S8/"~U>
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
\\)
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Q
N
TYPE OF WORK 0 New Construction ODeck o Porch ORe-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition o Alteration DUtility Connection
CODE: DI.R.C. DI.B.c. 9{'MiSC. /1I6',.19U.,4'1 17 07J ()r .s(l~ "'fl/8e
Type of Construction: I II III IV V A B PROJECT COST IV ALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: I 2 3 4 5
{,
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Park Support Fee
SAC
#
#
I hereby certify t I ve fl1mished mformation on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authonzcd agent for the
above-mentlO a pr erty and that all construction will confor 0 all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can v is pe' it for JU cause Irt rmore, I eby agree that the Clly official or a designee may enter upon the property to perform needed mspections.
Contractor's License No.
Permit Valuation
Permit Fee
(,00.00
$
$
$
$
$
$
$
$
TOTAL DUE
Plan Check Fee
Water Meter Size 5/8"; I";
Pressure Reducer
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
Other
#
#
1/-/9' ..tr'?
..~,
.,
$
$
$
$
$
$
$
$
$
This Application Becomes Your Building Pennit When Approved
Building Ollicial
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 requested. This document
when signed by the City Planner consl1tutes 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
4646 Dakota Street Prior Lake, MN 55372
BY:
Residential Building Permit Checklist
Basement Finish or Interior Alteration to Single Family Homes
Date: /(/9. ~/
Sa-ftK-
TUfb
BuUdin Permit # (J f/. 95"1 PID: z,C;:..J YO. ~O]..- 0 Zoning:
Site Address 172--50 11/f7lJ/1r/ bC-I::J LA<J.
Legal: L B
Existing Strnc~O
I CONFORMS TO ZONING
. ORDINANCE
Subdivision:
YES
NO
YES I NO
Is this an expansion of the existing footprint or Refer to Planning y;
building height?
Is the property located within the flood plain? Refer to Planning ~
Does the alteration include any additional kitchens? Refer to Planning f
Does the proposed alteration include any outside Refer to Planning )C
entrances other than patio doors?
Is the proposed use of the finished space or Refer to Planning \f
alteration for anything other than a normal single
family home (office, group home, day care, etc.)?
THIS CHECKLIST MUST BE COMPLETED AND INCLUDED IN THE BUILDING PERMIT FILE TO
MAINTAIN A RECORD OF THE REVIEW.
L:\TEMPLA TE\AL TCHCK.DOC
PRIOR LAKE
INSPECTION
RECORD
SITE ADDRESS 17ZS& hi7teJH rt6LLJ '-'N.
TYPE OF WORK .50~nle- 7V8t5
USE OF BUILDING ;Z6:( k/ L
, /
08" "0l) '9SCj DATE ISSUED //../9, ot
"
BUILDER 1'16NK.. ~ RON PHONE # ZSO. 7825
,
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
PERMIT NO.
INSPECTOR
DATE
IFOO~NG I
PLACE NO CONCRETE UNTIL ABOVE HAS
ifttJ FRAMING
:6 d' fb rr-tt,
~~rle; I FINAL l:4:U
1/'16
r
FOR ALL INSPECTIONS (952) 447-9850
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