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oF rR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �°_ S ��b
� AND UTILITY CONNECTION PERMIT
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2. Pink �,� PERMIT NO.O� ���
3 Ye�low Applicant /
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ADDRESS /���� ����_//��� I � �� �/ ZONING (ot�eice use)
Gi�
LEGAL DESCRIPTION (ofll'ice use only)
LOT BLOCK ADDITION PID ZS —Q �O
OWNER �`� I.
(Name) � � -QX�N�,�'tL ��'t� K �� (Phone)
(Address)
BUII..DER /�� --�
(Cotnpany'Name) l/l/��!?/�/� -.�'/1/G,�� (Phone) �r�e�^ 7�!' �77y�
(Cc�nEact Name) � S�/�� �� � ' � (Phone)
cA��� y �-O c� �_�P/�/1 L,� �� ,c
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connecrion
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B pROJECT COST/VALLTE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have fi�mished informat' n 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
abuve-menuoned property and that all con tion will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
ufficial can revoke this permit for j cau urthermore, I hereby agree that the city official or a designee may enter upon the property to perform necded �nspections.
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Signature Conuactor's License No. Dazt
Permit Valuation � U Park Support Fee # $
Permit Fee $ 8 "7 � SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ 2 0� Pressure Reducer $ _
.
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ � Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DLTE !� � v $ �$ _�
This Applicarion Becomes Your Building Pernut When Approved Paid Cel t NO. ,5��'
Date b < <i B
Buildin� Ofticial Date
Th�s is to certify that the request in the above application and accompanying dowments is in accordance with the City Zoning Ordinance and may proceed as requcstcd. This document
when signed by the Ciry Planner canstimtcs a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Ccrtificau of Occupancy must be
issued,
Planning Director Date Special Condidons, if any
24 hour notice for all inspections (952) 447-9850, fax (9S2) 447-4245
4646 Dakota Street Prior Lake, MN 55372
.� PRtp Date Rec'd
° � CITY OF PRIOR LAKE PLUMBING PERMIT
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z. aoia a� PERMIT NO. �,�
3. Yellow Applicant
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lease e or rfnt aud si a at bottoiu
ADDRESS ZONING (otNce use)
� �
LEGAL DBSCRIPTION (o�'ice use only) �
LOT BLOCK ADDITION �ID
OWNER �
(Name) U1�.� t.�dr�l�. C� on5�lvc,�.'u,. �� (Phone)
(Address)
APPLTCANT v ` D
(Name) Q l� S; aQ. 1� �Mb;n J (Phone) q, �9H• 2 600
(Address) _ L v'Z�I Z ra. A r� Sa v�o �5��
(Address) {City (Zip Code)
(Contact Person} �Cw�.. (Phone} � Sd - 89�if • � 600 _
APPLICANT SZGNATURE I DATE I � ad - !u _ —
" ' APPLICANT PLEAS� COiYiPLETE BELOW _
uanti e of I�'Izture uanti . e of Tizture
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
• Fluor Drain Water Sof�ener
Lavato Bathroom Sink Stand Pi e ashin Machine
' Laund Tra 1 or 2 com artment sink Sewa e E'ector
Shower Stall BF►ckflo�v Assembl
Sinks Backflow Assembl Test
Bar Sink La�vn S rinkler
Water Closet Toilet Other
FEE 5CH�DULE
Industrial, Cominercial &. Mald-family 1°h of job cost with a�49.50 minimam Residential, New One 8c Two-Family S 149.50
Residentiai, Additions & Atterations $49.SQ
Bstimated Cost $ Building Permit #
ee �� �•I�erS
- PLUMBING PERMIT FEE $ � �
STATE SURCHARGE $ 0 �2f1��
TOTAL PER1V.[TT FEE �(� I. IT
(Oftice Use On�y}
Tl�fs Becomes Your HuiIding Permit When Appraved : Paid lteceipt No. __
Datc By .
Buttdin¢ bt[icial AaEe
241iour nottce for all inspections (952) 447-985b, fax (952) 447-4245 .
4646 Dakota Street 3.E„ Prlor Lake, Minnesota 55372
DEP�RTMENT OF
P R 1 CJ R LA K E ��lILDINC AND lNSPECI'IUN
E T R R
1 �i
P 1 N � D
SITE ApDRESS � � '
NATURE OF WORK �`
USE OF BUILDING
PERMIT NO. • DATE ISSUED .
CONTRAGTUR PHONE ,�j,�. 'TZ�. �
NO'TE: THIS IS MOT A PERMIT FOR ANY OF TME 1NSPECTIONS BEl.01N
THE PERMIT IS BY SEPARATE DOCUMENT
�s�croR na►r�
Pi.ACE N� GONCRETE UN7iL ABOVE HAS $EEN SIGNED
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C�JVEi� N� WORK UNTiL ABflVE #�1AS BEEN StC�Nf �
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t�t� #UOT �CCUPY UIVTML AB�VE HA5 BEEN SIGNED
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This c.�uc� must bs -pos�d near an ei�c#rtc�l a�rvica cabine�t prlcr to rc►�gh-in Mspections
and maintainsd ur�t�l aH �n*p�ctions hava b� �ppravad. t;'�n buildi�gs and additfons
vvhere no servi�e +q�binr�t is �vai[��le, car�! shrft be� placed near main entrsns�e.
Fo� �►�� �N��ECT�a�s ����� �7-�v