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CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE /Z p /0
AND UTILITY CONNECTION PERMIT
l *N E S O�
1
2. Pink 1 city PERMIT NO.
3. Yellow Applicant /0 . / /��
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
163 I 0 T L, 14 t. CT �
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
\ rl Si, (C)
(Name) � G VI d Ck g � GG. � � � Z (Phone 71 s l �60 our
(6 3 1 0 "a L1 Atka- Cr NW
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ['Deck ❑Porch ❑Re- Roofing ❑Re- Siding ewer Level Finish ❑ Fireplace
['Addition ['Alteration ['Utility Connection pN J. beo(roDin-
�oMple�¢ Iv�Je�.eN-t
CODE: ❑LR.C. ❑I.B.C. ❑ Misc:
Type of Construction: I II III IV V A B
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $ 1/ 0266
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I 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. Lam aware that the building
o cial can oke is 't r just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
/) -6 0 (6
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ 3 7 e L 75 SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ J 0 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 DUE $ 3 9' 75
This Application Becomes Your Building Permit When Approved Paid 3 ? j Rec t No. 67 / x/77
Date /7_ . /(c B . -
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 S.E., Prior Lake, Minnesota 55372
P R I O R LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS /6 77W/AI ,C (7
NATURE OF WORK LOW62 -12 / 72-/'/ ,
USE OF BUILDING /.r •472
PERMIT NO. /0. //....3g DATE ISSUED / • 9- / d
CONTRACTOR PHONE 7/5 4 U��5
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING � ooYt 3Jji,
INSULATION &J h:/ &&
ELECTRICAL
HEATING (if required) 63kciLlelra 3hyp
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
( � I
FINALS
BUILDING
ELECTRICAL
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