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of PRI6 CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
,, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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4f'NNE I. white File PERMIT N
2.
Pink City � ' ` `
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3
3 Yellow w Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/ 4 r6 i.0 i'd) fJ I/
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) p c. v I . , ;t= 6 i ;� (Phone) (cif Z ) 4/0.4— 0 Y.', J
(Address)
BUILDER
(Company Name) (Phone)
(Contact Name) _ (Phone)
(Address)
TYPE OF WORK ❑ New Construction eck ❑Porch ❑Re- Roofing ['Re-Siding ['Lower Level Finish ❑ Fireplace
['Addition ['Alter o ['Utility Connection
CODE: E.R.C. ❑LB.C. ❑ Misc.
Type of Construction: I II III IV V AB PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
1 hereby certify that 1 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
official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
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Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $ e.
Plan Check Fee $ 57:3C4 Water Meter Size 5/8 "; 1 "; $
State Surcharge $ 1 J Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $ i
Gas Fireplace Permit Fee $ TOTAL DUE $ (4 7. 1 1
This 4r,plic ati Becomes Your Building Permit Whe ' A roved Paid t 11- % C Receipt No. cr=tOs-i 4
Date k9 1 2 4("? By kZ,NA_'
Building °Mc Date
This is to certify that t e request in the above application and accompanying do iments is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signeI.y� e -', Planner constitutes a temporary Certificate of Zoning omplia e and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued. 1
`_ 1 °v
Pl. ning Director ate Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372
•
•
Residential Building Permit Checklist
; 1 Deck Additions to Single Family om s
BY: " �r '�`� Date:
Building Permit # _. PID: Zoning:
Site Address
Caw t 1
Legal: L B Subd ision:
Existing Structure: or NO
CONFORMS TO ZONING - . • • NO
ORDINANCE •
Yard Setbacks: NOT APPLICABLE Requirement Proposed
MEETS CODE '
• Side Yard 10'
(25' if abutting a street, 30' if abutting a street in . ' f
Cardinal Ridge)
• • Side Yard : • .. 10' r
• Rear Yard • 25' •,/') r.
• • Townhouses .Must be consistent with
approved plan for
. development
ANY PROPOSED DECK NOT MEETING THE ABOVE CRITERIA MUST BE REFERRED TO THE
PLANNING DEPARTMENT. ALSO, ANY DECK ON A LOT WITH A SUSPECTED BLUFF, OR ANY
OTHER UNUSUAL CIRCUMSTANCE MUST BE REFERRED TO THE PLANNING DEPARTMENT.
THIS CHECKLIST MUST BE COMPLETED AND INCLUDED IN THE BUILDING PERMIT FILE TO
MAINTAIN A RECORD OF THE REVIEW. -
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K ( Z
' L: \TEMPLATE\DECKCHCK.DOC
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS /4 ®( - �%✓,��
TYPE OF WORK 74 ='"
USE OF BUILDING / 4 if—
PERMIT NO. /LD - s( DATE ISSUED v /d
BUILDER b-+Vrtn J cob s ue/ PHONE # /s -4o4 -0935
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR pATE
I FOOTING — , &./ti- j
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
� /. 1 fl/Il 9/70
I FINAL I 4h 00
FOR ALL INSPECTIONS (952) 447 -9850