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of PRi CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
AN TEM ft,
PORARY CERTIFICATE OF ZONING COMPLIANCE
y AND UTILITY CONNECTION PERMIT
4f'NNEso�P I. White File pERMIT NO
2
3 Pink Cpy 0 '' ( 1 1 /
3 Yellow Applicant 1 V
r (Please type or print and sign at bottom)
•.,„,/ ADDRESS ZONING (office use)
1 53 V 2 ,frou s ly 5/ .5: oe L�•/e.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER ��
(Name) loo /ait c / ,S%POW'v (Phone) 9,52. - 'Y'/ > - 4 z.53
(Address) 5 «2 /du n, 57 5 ,4 , "HA) ,S.S37Z
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ['Deck ['Porch ❑Re- Roofing ❑Re- Siding ower Level Finish ❑ Fireplace
['Addition ❑Alteration ['Utility Connection �,y
-Fi
❑ Misc. 4 ' / i 'O ®M
CODE: I.R.C. ❑I.B.C. I
Type of on truction: I II III IV V AB PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding
Division: I 2 3 4 5
I hereby certify that I have furnished information on this application which is to the best of my knowledge tnte and correct. I also certify that 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 submitte• • ans. I am aware that the building
official can - oke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform need nspections.
L �EC 2 p / v
X I /L/_�., �. �. '
Signature Contractor's License No. 1 to
Permit Valuation (Do, Park Support Fee # $
Permit Fee $ 34,.,S-- SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $ �,\,,,
State Surchar e $ Pressure Reducer $
g 5.60
Penalty $ Sewer /Water Connection Fee # $ \
Plumbing Permit Fee $ 5.4 5o Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
/
Gas Fireplace Permit Fee $ TOTAL DUE $ l 4 . 2 - 5
This 1' ati Becomes Your Building Permit When Approved
1 Z_/1- 4 ° Paid �� Recei.t No. e�g'
Date B 'O7�1/•; —
Bui d •• Oftic,ial '' ate
This is to certify that th 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 • the Ci Planner constitutes a temporary Certificate of Zoning compli nce and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued. i
AA ���'', IZ !v
Planning Di or 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
pR Date Rec'd
3�
fl A CITY OF PRIOR LAKE PLUMBING PERMIT
- x
v r'
ji'NESD•
-
Blue I 2 Gold File PERMIT NO . /p
. Ye pp s"
3. Yellow Applicant `�
(Please type or print and sign at bottom)
ADDRESS / ZONING (office use)
:
5 `/o ,acr„ -41 f 5 � - /I rso.E' ZetE'
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) /CO�an el diez) 60A) (Phone) 952— '/v 7 — 4 0,5`3
(Address) .53y2 , 4; 7 51 5E ' a.r LJ ' /*' 377_
APPLICANT
(Name) (Phone)
(Address)
(Address) (City) (Zip Code)
(Contact Person) (Phone)
7< APPLICANT SIGNATURE 6%-x 94 cl71-- DATE 4 /me, 2, z 4, / 0
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher Water Heater
Floor Drain Water Softener
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
X Shower Stall Backflow Assembly
X Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi - family 1% of job cost with a $49.50 minimum Residential, New One & Two - Family $149.50
Residential, Additions & Alterations $49.50
/
Estimated Cost $ Building Permit #
PLUMBING PERMIT FEE $ 00 , 4../
STATE SURCHARGE $ .50 t
TOTAL PERMIT FEE $
(Office Use 0 ly) ,
This , , 11 c t i n Becomes Your Building Permit Wh n A proved Paid Receipt No.
Date By
But .. Official Da e
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
PRIOR LAKE BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS ti=p 1 Z
NATURE OF WORK F iNtSR �5�- -*���
USE OF BUILDING 0-e-4; A J
PERMIT NO. t o -- (10a DATE ISSUED 1Z I Z l I
CONTRACTOR FoL. R PHONE 4 41 - 6)
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
iF. 1
1.
Backfill) 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
IC
FRAMING 2 PI* t lit (
1
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
_FIREPLACE
T
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1 1
FINALS
Sodding)
-BUILDING
ELECTRICAL
PLUMBING fix() S op
HEATING
DO NOT OCCUPY UNTIL 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