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Q Fiir04, CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
'r_ A NI TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
_.
AND UTILITY CONNECTION PERMIT 9 /I
*NE $°
I. White i` PERMIT NO
Z C NO. Pink City i 3
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS _ ZONING (office use)
is - wed I$i-4 V)r '!2v,4 -.1> /s/. re.,
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER '
(Name) . °t' 1 r .J -,r. s Lam IL (Phone) e 1S 2 - /VO A .sr1'6
(Address) rS >3 j, /6 z..4-- ll ~tv rive ' f -/. 44...,
BUILDER
(Company Name) s7) t/� F c es)4b7l7l,G7k , (Phone)
(Contact Name) S7k: V/R. J- 17 1015 (Phone) / - .. - e , 7 - 94,0 0 7
(Address) 32_40o S7"t i y /-sS ft u.v- D i N F/-1 17 SG! ,/1Jr 4 %5'
TYPE OF WORK ❑ New Construction ['Deck ❑Porch ❑Re- Roofing DRe-Siding DLower Level Finish ❑ Fireplace
DAddition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ELB.C. N Mist: &)M 0 IC4ir7ufre m ll-/ Lowe/7 LC VI t
Type of Construction: 1 If ITT IV V A B S1 Pee V 36p17' l
Occupancy Group: A B E F II I M R S U PROJECT COST /VALUE $ ' '7 €��. --
Division: 1 2 3 4 5 (excluding land)
I hereby certify that f 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
of 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.
X TD. ..t✓ / `I/'2.7 /6
Signature Contractor's License No. Date
Permit Valuation 2 RooMs Park Support Fee # $
Permit Fee $ G a. 2- SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1"; $
State Surcharge $ Js' I r7G Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ $ 4/ • sO Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE / $ / Z 1 75
,.,.. 11 'on B: . mes Your Building Permit When Approved Paid /2 / U Ce1pt No. (p�� �/ 7
i l Date / 4 C ' y
Bu' Sing Official ate
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
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS 1S7S(o
NATURE OF WORK I... L.
USE OF BUILDING SFb
PERMIT NO. 11.., 368 DATE ISSUED li/a9/
CONTRACTOR Jo I PHONE 2 q'/6..z
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I N&°' I j
16 14 ( - (Pftor to Backfill) 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING r 11,10
INSULATION U ATION riA /111i/
ELECTRICAL
PLUMBING
HEATING (if required 1 C, 12,l
igfIREDIAtrig
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I j
FINALS
9 lte4 lidd
BUILDING 6
ELECTRICAL
PLUMBING
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