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P12./ TEMPORARY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
ARY CERTIFICATE OF ZONING COMPLIANCE /6,. a / 0
x AND UTILITY CONNECTION PERMIT
T...) r=i
M ___'NESoiP I. White File r
2. Pink City PERMIT NO. / 0 730
3 Yellow Applicant /
(Please type or print and sign at bottom)
ADDRESS 1 /)E,&f / ZONING (office use)
; '77 «)&
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER `A <4V? I I f
(Name) f (Phone) 6 /2. - A `�'��
v�✓ �•
(Address)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ['Deck ❑Porch DRe-Roofing ❑Re- Siding Lower Level Finish ❑ Fireplace
❑Addition ['Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V AB PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U
Division: 1 2 3 4 5 (excluding land)
I her .y cer ify that I ha t • - - : inform. ion on this ap 'cation which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
ab a -men .. d pro •r and that . 1 co..tructio will con rm to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
o ' cial c.,iriel is , rmit for ju c . e. Furt , hereby agree that the city official or a designee may enter upon the property to perform needed mspec ' ns.
x A �w % � /j ; f0 18 /ID
• Signature Contractor's License No. Date
Pe • it Valuation Park Support Fee # $,
Permit Fee $ ?`/. S SAC # $
Plan Check Fee $ ,---- Water Meter Size 5/8 "; 1 "; $
State Surcharge $ S Uv 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 $ 37. 7 s
This Application Becomes Your Building Permit When Approved Paid 3 `f, 7f ceipt No. G/ 7
Date `0,/3,,7d
Building Official 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 constitutes 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
t
Residential Building Permit Checklist .
Basement Finish or Interior Alteration to Single Family Homes
BY: Date: /0,/3, (C)
Building Permit ,TG/(' 90 ) PID: Zoning:
Site Address
3 7 7 - Bf2-C oIcs K-
Legal: L B Subdivision:
Existing 5 tructur : YES o O
CONFORMS TO ZONING YES NO
ORDL :- NCE
1 YES ■■-o
Is this an expansion of the eitiszng footprint or Refer to Planning
building heir t?
Is the property located within the flood plain? Refer to Planning
Does the alteration include any additional Ictchens? Refer to Plain?
Dees the proposed alteration include any outside. Refer to Planning
e i races other than patio door? V
Is the proposed use of 'welshed space or Refer to Planning
alteration for anything other than a normal single
family home (office, ;roup home, day care, etc.)?
THIS CHECKLIST MUST BE COMPLETED . YD INCLUDED IN THE BUILDING PE.R.LNIIT FILE TO
NCALNTAIN A RECORD OF THE REVIEW.
DEPARTMENT OF
P RIOR LAKE DEPARTMENT
AND INSPECTION
INSPECTION RECORD
SITE ADDRESS 52-77 „/2 t
NATURE OF WORK LOWC L6Ve lWe7D E
USE OF BUILDING Leff /9//Z-- O. /�, �U _
PERMIT NO. /0, P DATE ISSUED
CONTRACTOR w / � PHONE 6/2-- 2-&l 4-53
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
1 1
I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING f) d(
INSULATION
ELECTRICAL
HEATING (if required)
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1 1
FINALS
BUILDING (d //
ELECTR
HEATING
DO NOT OCCUPY U TIL 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.
FOR ALL INSPECTIONS (952) 447 -9850