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o f PR /p� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
0 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
i. x AND UTILITY CONNECTION PERMIT
U trj
A 'i NNE S0�P I. white File PERMIT NO .
3 Yellow A Pink A p y plicant ( O '' 1�
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(Please type or print and sign at bottom)
ADDRESS a t3 T ( i wVt �- n , , ^ �� ZONING (office use)
3 n c�.- 1`l �D (>e. e IA 1 .7 0 " � c 5 3
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER n/� r,,
(Name) I A breeii (Phone) - (4la -�1O (0D-
(Address) 021 f 6S . mOfT A-u-e_. J hC1`..I L.: oe. 1'r ► N 553--iq
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction "IDeck ❑Porch Eke- Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
['Addition ['Alteration ['Utility Connection
CODE: FaR.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B PROJECT COST /VALUE $
Occupancy Group: A B E F I I I MR S U
Division: 1 2 3 4 5 (excluding land)
I 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 nstruction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official . • revoke tt permit for ju , c i se. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X ! ,1 4r _ u Sce ( 0
Stnature Contractor's License No. Date
Permit Valuation oe70� Park Support Fee # $
Permit Fee $ 8 $ ZS SAC # $
Plan Check Fee $ 51 • 3 fca Water Meter Size 5/8 "; 1 "; $
State Surcharge $ 1 . So 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 DUE $ ( 4- I
This Appli 'o : eco t es Your Building Permit en A proved Paid I • Receipt No. 1i
4 Date \ 3( �o By , _
filaiii■ Ilk (40
Buil ing Ofticia Date
This is to certify that the request in the above application and accompanying docum is • in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed ', • C� Planner constitutes a temporary Certificate of Zoning com is e and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued. I
1 k <o
' annin l 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
. ...Residential Building Permit Checklist • • • ' • ck Additions to Single Fami . mes • •
•
BY • /4 Date: ? - •
3(o
Building Permit # Zoning: _
• Site Address
• Legal: L B . Subdivision:
• Existing Structure: YES or NO • 0 • •
• • 0 CONFORMS TO ZONING • . • • NO -
ORDINANCE . . - 0 - - - •
Yard Setbacks: NOT APPLICABLE Requirement Proposed •
• 0 • MEETS CODE - - •
• Side Yard • - 10' -
. (25' if abutting a street, 30' if abutting a street in - ' ' •I -
• Cardinal Ridge) • .
• - • - Side Yard : - 10' •
• - • • Rear Yard • • _ - 2 5'
• • • Townhouses Must be consistent with
approved plan for •
• 0 • • development • • •
• 0 ANY PROPOSED DECK NOT MEETING THE ABOVE CRITERIA MUSTBE 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. • . - •. . ..
•
( ,( , y
•
' • • - '• L : \TEMPLATE\DECI CHCK.DOC .
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS 2-t Ak.,.s
TYPE OF WORK a�
USE OF BUILDING fies
PERMIT NO. t o • 15 Z DATE ISSUED 131,0
BUILDER 4 Nc tea. s PHONE # 45z• �ttz - 7 o�Z
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR D TE
f�
I FOOTING « `- 1 1, I ?/ /
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
1 1 1
I FINAL 1 /3,%u1/f 1
FOR ALL INSPECTIONS (952) 447 -9850
APPROVED
PLANNING DEPT
Signed /*Od Date ( (a IL
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