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of PRI CITY OF PRIOR LAKE BUILDING PERMIT, Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIA s \ , E
x AND UTILITY CONNECTION PERMIT C
2011
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��NNBS��� 1. White File
2. Pink City PER NO. a. —
3 Yellow Applicant _ '�� _ -
Please . • or ./int and si _ at bottom)
ADDRESS ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) el, I Piik..5 "OA (Phone) / c — %'1 7 - 1 /$77
(Address) 1 -! if 5'. cq+ .. rl- • s e .
BUILDER A,. / 7)1-
(Company Name) J 4fr!
) 6-.• 4 fc ..fir nZ j 4 ea • hone) C� )a'' D Su .9--
(Contact Name) J / L A / re- A �— (Phone , --0 S'Z Z
(Address) J) 3 1 pitA "< 4 ✓4- Pr1.3 r L:.)1•.(e-
TYPE OF WORK ❑ New Construction beck ❑Porch ❑Re- Roofing DRe-Siding ❑ 4wer Level Finish ❑ Fireplace
❑Addition ❑Altera ion ❑Utility Connection
CODE: R.C. ❑I.B.C. ❑ Misc. �^
Type of onstruction: I II III IV V A B PROJECT COST /VALUE $ 6� Jd0�
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
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 1 am the owner or authorized agent for the
above- mennone, 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
official can rev , e this pe -- it for just ause Furthermore, 1 hereb . gree that the city official or a designee may enter upon the property to perform needed inspections.
X / AP a(.d' 345 5 $"0 -3.0J)
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ ��, �� SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ 4-1 ' • CC A Pressure Reducer $
M
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 $ f Z�,
This • tff . Becomes Your Building Permit ' , ■ oved Paid i Recei et s . — 5 Z'
�� Date e B to w
- I
Si ins Official Oat.
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 e- a 9---//
Planning of ctor 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 -
- - Deck Additions to Single Fami . Ho s
BY: , D ,
ate: 5 , i
Building Permit : PID: Zoning:
Site Address l
Legal: L B Subdivision:
Existing Structure: ES r NO
1
CONFORMS TO ZONING YES , NO
ORDINANCE
Yard Setbacks: NOT APPLICABLE Requirement Proposed
MEETS CODE
• Side Yard 10,
(25' if abutting a street, 30' if abutting a street in
Cardinal Ridge) 74r
• Side Yard 10' ' f
• Rear Yard 25'
• Townhouses Must be consistent with • 75:(
approved plan for
development
ANY PROPOSED DECK NOT MEETING THE ABOVE CRITERIA MUST BE 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.
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PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS (4
TYPE OF WORK
USE OF BUILDING Tz 442--
PERMIT NO. t DATE ISSUED 4 r,
BUILDER 3,4-,4N rt(CU C_. PHONE #
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
' CTOR DATE
FOOTING WATO. &M
PLACE NO CONCRETE UNTIL ABOVE HAS BEE IGNED
401111altek_
I FINAL 1 4 , 1
FOR ALL INSPECTIONS (952) 447 - 9850